A pre-surgery blood test or a pregnancy check-up comes back “HBsAg reactive”, and the first question at home is often about money: how much will this cost, and for how long? The finding is not rare. In India’s 2021 HIV Sentinel Surveillance data, about 0.85% of people tested positive for hepatitis B, roughly 1 in 118, a Government of India backgrounder noted in July 2026.
The answer depends first on whether you need treatment or only monitoring. Below: the tests and their government reference rates, tablet prices, where both are free, and what insurance covers.
Key Takeaways
- A positive HBsAg does not always mean tablets; many people need only regular blood tests.
- The National Viral Hepatitis Control Program (NVHCP) offers free hepatitis B testing and treatment at government centres.
- HBV DNA (viral load) is the costliest routine test: ₹2,975-3,500 at the government’s CGHS rates for Tier 1 cities.
- At Jan Aushadhi prices, generic tenofovir costs about ₹606 a month and entecavir about ₹281.
- Tablets control the virus but do not clear it in most people, so treatment is usually long term.
What HBsAg positive means for the bill
Definition: HBsAg (hepatitis B surface antigen) is a protein from the outer coat of the hepatitis B virus. A positive result means the virus is present; if it stays positive for six months or more, the infection is chronic hepatitis B. In some people the virus stays quiet and spares the liver (often called the inactive carrier state); in others it slowly scars the liver.
India’s national hepatitis B guidelines (NVHCP, 2019) estimate that 15-25% of people with chronic hepatitis B are likely to develop cirrhosis or liver cancer. The tests below show which group you are in, and that sets the cost. How the virus spreads and harms the liver is covered in the guide to hepatitis B symptoms, transmission and treatment.
Who needs treatment and who only needs monitoring
The national programme decides on cirrhosis, SGPT (ALT), HBV DNA and platelets, not on the e-antigen (HBeAg) test. “Persistently raised” SGPT means two readings above the lab’s upper limit, four weeks apart, within six months.
| Your results | National programme advice |
|---|---|
| Cirrhosis, or APRI above 2 or FIB-4 above 3.25 | Treat, whatever the SGPT or HBV DNA |
| SGPT persistently raised, HBV DNA above 20,000 IU/mL | Treat |
| SGPT persistently raised, HBV DNA below 20,000 IU/mL | Treat if APRI is above 1.5, FIB-4 above 1.45 or platelets below 1,00,000 |
| SGPT normal, HBV DNA above 2,000 IU/mL | Treat if the same scarring signs are present |
| SGPT normal, HBV DNA below 2,000 IU/mL | No tablets; keep monitoring |
APRI and FIB-4 are scarring scores worked out from routine blood results and age, at no extra cost.
The World Health Organization’s 2024 guideline is broader: it advises treating people with significant scarring (APRI above 0.5 or liver stiffness above 7 kPa), HBV DNA above 2,000 IU/mL with raised SGPT, or added risks such as diabetes, fatty liver or a family history of liver cancer. WHO estimates this covers at least half of HBsAg-positive people, against 8-15% before. Your gastroenterologist weighs both.
Hepatitis B test cost: work-up and follow-up
Private prices vary by lab, city and hospital. The nearest public benchmark is what the Central Government Health Scheme (CGHS) pays empanelled hospitals, in a rate list effective 13 October 2025. Below are its Tier 1 city rates (Delhi is Tier 1), non-NABH to NABH-accredited. At NVHCP centres the programme’s tests are free, and its guideline treats a FibroScan liver stiffness scan as optional where cost is a constraint.
| Test | What it shows | How often (NVHCP) | CGHS rate, ₹ |
|---|---|---|---|
| HBsAg | The infection | At diagnosis; again at 6 months if recent | 255-300 |
| HBeAg | A more active phase | Optional | 306-360 |
| HBV DNA, quantitative | Amount of virus | At the start, then yearly | 2,975-3,500 |
| LFT, with SGPT and SGOT | Liver inflammation | Every 6 months | 425-500 |
| CBC with platelets | Feeds APRI and FIB-4 | Every 6 months | 255-300 |
| Ultrasound, whole abdomen | Cirrhosis signs or a growth | At the start; every 6 months with cirrhosis or a family history of liver cancer | 680-800 |
| FibroScan | Liver stiffness (scarring) | At the start, where available | 978-1,150 |
| Serum creatinine | Kidney safety on tenofovir | Every 6 months on tablets | 85-100 |
At these rates, a first work-up of the first seven tests comes to roughly ₹5,900-6,900. A year of monitoring without tablets (two LFTs, two blood counts, one HBV DNA) costs about ₹4,300-5,100, plus any scans advised.
Is hepatitis B treatment lifelong?
Usually, yes. The national guideline says the tablets suppress the virus and lower the risk of cirrhosis, liver cancer and death, but do not eradicate it in most people, so treatment is potentially lifelong. Stopping is considered only in select cases, with SGPT checks at least every 3 months for a year afterwards, because the virus can flare. Budget for it as a monthly cost, like blood pressure tablets. Hepatitis C is different, as the comparison of hepatitis B vs hepatitis C explains: a 12-24 week course clears it in nearly all patients.
Tenofovir cost and the other tablets
India’s guideline names two first-choice tablets, each taken once a day: tenofovir disoproxil fumarate (TDF) and entecavir. Tenofovir alafenamide (TAF) is kept for kidney or bone problems. Older drugs such as lamivudine are not advised, because resistance develops.
| Generic medicine | Tablet strength | Jan Aushadhi MRP | About per month |
|---|---|---|---|
| Tenofovir disoproxil fumarate | 300 mg | ₹202.13 for 10 tablets | ₹606 |
| Entecavir | 0.5 mg | ₹93.75 for 10 tablets | ₹281 |
| Tenofovir alafenamide | 25 mg | ₹562.50 for 30 tablets | ₹563 |
These MRPs are from the Jan Aushadhi product list, checked on 6 October 2026; branded prices vary by company. Under NVHCP, tenofovir and entecavir are free.
Entecavir is not recommended in pregnancy, so tenofovir is preferred for women who may conceive; entecavir may suit people over 60, or with weak bones or reduced kidney function. Never switch tablets or stretch a strip without your doctor.
Free hepatitis B treatment in India
Since 2018, NVHCP has offered free screening, diagnosis and treatment at designated public hospitals, from tertiary centres to district hospitals. Complex cases go to model treatment centres; stable patients can collect tablets closer to home, with a review every 3-6 months.
What insurance usually covers
- Standard policies cover admissions; OPD tests and monthly tablets usually fall outside unless the policy has OPD cover.
- Hepatitis B diagnosed or treated in the 36 months before you buy a policy counts as a pre-existing disease; disclose it. IRDAI caps the waiting period at 36 months.
- For complications, NVHCP links patients to schemes such as Ayushman Bharat.
What moves the total
- Whether tablets are needed at all.
- Where you test. CGHS’s own rates are 15% lower at non-NABH centres and 10-20% lower in smaller cities.
- The stage of liver disease. In a Delhi hospital study of 389 people with chronic hepatitis B or C, yearly costs ran from ₹16,600 to ₹17.09 lakh, rising with severity.
Protecting the family
The national guideline advises testing family members and sexual partners, and vaccinating those not infected. HBsAg shows who is infected; an anti-HBs antibody test (CGHS rate ₹553-650) shows who is already protected.
What’s changing
WHO’s 2024 guideline backs point-of-care HBV DNA tests and “reflex” testing of the same blood sample, so fewer visits are needed. The gap is wide: in 2019, WHO estimates, only 10% of 296 million people with chronic hepatitis B had been diagnosed and 2% treated. In India, NVHCP services are moving from district hospitals to local health centres.
Conclusion
For many people, a positive HBsAg means blood tests twice a year rather than tablets. When treatment is needed, generic tablets cost a few hundred rupees a month, and NVHCP centres provide tests and tablets free. The larger cost is the cirrhosis unmonitored infection can bring.
Hepatitis B positive on a report? Bring your HBsAg report and any SGPT, HBV DNA and ultrasound results, and ask whether you need tablets or only monitoring. Dr Sushrut Singh, a gastroenterologist with a DM from ILBS, New Delhi, consults at Fortis Hospital, Sector 62, Noida, and at his clinic in Gaur City 2, Greater Noida West. Call or WhatsApp 093153 54431.
Frequently Asked Questions (FAQs)
How much does an HBV DNA test cost in India?
It varies by lab and city. The CGHS rate in Tier 1 cities is ₹2,975-3,500; the test is free at NVHCP centres.
Is hepatitis B treatment free in India?
Yes, at government treatment centres under NVHCP, for people who meet the treatment criteria.
My viral load is undetectable. Can I stop tenofovir?
Not on your own. Undetectable means the tablet is working; stopping can let the virus flare.
Will health insurance pay for hepatitis B tablets?
Usually not, unless the policy has OPD cover. Admissions are generally covered, after any pre-existing disease waiting period.