OBJECTIVES: To estimate the annual average per patient cost for diagnosing and treating chronic hepatitis B (CHB) and its complications in three large metropolitan cities in India. METHODS: Health resources consumed during the diagnosis and treatment of CHB and its complications were estimated by administering a structured survey to a total of 30 participating physicians from 3 cities (8 hepatologist/gastroenterologist and 2 oncologist treating hepatocellular carcinoma patients per city). Equal number of physicians from private and central government health scheme hospitals (CGHS) participated in the survey. Cost for laboratory tests, imaging, procedures, hospital admissions, physician visits, and drugs received on an inpatient and outpatient basis were estimated using rates provided by private setting centres and CGHS approved rates in the 3 cities. Mean, median, standard deviation, and frequency were used to analyze data. RESULTS: Total annual average cost for treating CHB, compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC) were INR 79,768 (USD 1,269), INR 53,223 (USD 846), INR 3,99,316 (USD 6,355), and INR 5,069,12 (USD 8,067) in a private hospital and INR 49,796 (USD 792), INR 33,976 (USD 538), INR 2,73,564 (USD 4,353), and INR 358,071 (USD 5,698) in a CGHS hospital, respectively. The added inpatient cost of undergoing liver transplant for eligible HCC patients was on an average INR 25,00,000 (USD 39,783). CONCLUSIONS: Findings from our study provide an initial understanding of the magnitude of direct medical cost burden that CHB and its complications impose on patients in India. The results highlight the increasing health-care cost related to disease progression which can be potentially reduced by effective prevention strategies, early treatment, and patient education to improve adherence to treatment. Future efforts should focus on conducting large observational studies using patient level data and develop models to support uptake of cost-effective strategies to manage the burden of CHB in India.