Background: Hepatocellular carcinoma (HCC) is a complex disease with treatments that may include locoregional therapy (LRT), systemic therapy and liver transplant. Using retrospective real-world data from a tertiary care hospital in British Columbia (BC). We examined characteristics, treatment pathways, survival and relevant healthcare costs of HCC patients. Methods: This was a retrospective, real-world data study using data from two existing chart review studies (called MOTION and HCC) and the BC Transplant database. The Canadian province of British Columbia has a population of 5.0 million who receive medical coverage under the Medical Services Plan. “MOTION” collected data on patients who received LRTs between 2004 and 2017, while “HCC” collected data on patients who received systemic therapies between 2000 and 2019. MOTION and HCC and Transplant data were linked and patients were assigned a unique study number and personal health information (PHI) was removed. Start and stop dates for LRT and systemic therapies were used to determine treatment patterns. Treatment costs were provided by BC Cancer’s Pharmacy department, medical oncology visits were assumed to be monthly while patients were on systemic treatment, LRT costs were based on departmental expenditures, and the cost of a liver transplant was provided by the regional health authority. Analyses used descriptive statistics for baseline characteristics, duration and costs (in 2021 Canadian dollars) and Kaplan-Meier curves for survival. Results: There were 417 and 413 patients from the HCC and MOTION databases respectively, in which 63 patients were in both (referred to as the “common” group). Median age (years) at diagnosis was 64, 62 and 62 for HCC, MOTION and common groups respectively, while the proportion who were female was 17.5%, 18.2% and 15.9%. Median overall survival (mOS) from diagnosis was 21, 33 and 28 months for the HCC, MOTION and common groups, respectively. From start of systemic treatment, mOS was 9 months for the HCC group, 29 months from first LRT for patients in the MOTION group, and 26 months for the common group from first treatment. Treatment and cost results were based only on the common group: mean length of follow-up from diagnosis was 34.6 ± 26.2 months and mean time from diagnosis to first treatment was 4.7 ± 4.2 months. DEB-TACE was most frequently the first LRT, often received 3 rounds of LRT before starting systemic treatment, in which sorafenib was given mostly as first line systemic therapy. When including only costs related to LRTs, systemic therapies, medical oncology visits and liver transplants, the mean cost per patient was $94,419, resulting in $51,649 mean cost per patient per year. Conclusions: The linkage of HCC-related LRT, systemic and transplant databases provided detailed results related to the treatment patterns, survival and costs of HCC patients in Canada.