OBJECTIVE: To estimate the patterns of medical care and associated direct medical costs of managing chronic hepatitis B virus (HBV) in France. METHOD: Five stages were identified to describe the natural history of the disease: Chronic hepatitis B without complications, compensated cirrhosis, decompensated cirrhosis, hepatic transplantation (first and second year), and hepatocellular carcinoma. Standard care and corresponding items of medical resources for these different states of health were defined on the basis of a literature review and the conclusions of an experts panel. Resources included offices visits, procedures, laboratory tests, drugs (including antiviral drugs), and hospitalizations. For each state, the annual mean unit direct medical costs were estimated using the weighted proportion of patients using the resource. Unit costs (2001 value) were nationally available from the perspective of the French national insurance. RESULTS: Approximately 24% of HBV patients are managed with antivirals but these medications accounted for approximately 45% and laboratory tests for 30% of treatment costs in the chronic HBV state (€1093). The mean annual treatment costs for the more advanced disease states were: compensated cirrhosis €1,134, decompensated cirrhosis €8,842 (due primarily to hospital admissions), hepatic transplantation €84,568 (first year) and €9,147 (second year), and hepatocellular carcinoma €9,352. CONCLUSIONS: Treatment patterns for HBV vary across centers in France. The average treatment costs indicate a substantial financial burden of HBV that increases with advanced stages of the disease. Preventing HBV or its advance could result in lowered long-term treatment expenditures.