OBJECTIVES: Myelodysplastic syndromes (MDS) are a group of myeloid neoplasms characterized by cytopenias and increased risk of leukemic evolution. Patients are categorized as having higher-risk or lower-risk (LR) MDS. Management of LR-MDS is essentially aimed at treating anemia through repeated transfusions. The objective of this study was to assess transfusion burden and possible related complications. METHODS: Using data from the French PMSI-MCO nationwide hospital discharge database, patients with an MDS code who were hospitalized as an inpatient or outpatient, and received a transfusion between 2012 and 2013, were included in the analysis and followed until December 31, 2018. Patients with <1 transfusion every 2 months in the first year of inclusion, or those presenting with high-risk criteria (chemotherapy, acute myeloblastic leukemia, azacitidine administration) were excluded. Resource utilization was considered from a National Health Insurance (NHI) perspective. Survival time was assessed using a Kaplan–Meier model. RESULTS: The analysis included 5,081 patients, with a median age of 81 years, followed for a median of 10.9 months; 87.6% of hospital stays included a transfusion. The intra-hospital mortality rate was 64.9%. A median of 15 transfusions, representing a cost of EUR 19,789 was described per patient per year of follow-up. 1,628 (32.0%) patients had ≥1 hospital-stay related to transfusion complications (representing 2.8% of all stays) with a median total cost of EUR 6,645 per patient. CONCLUSIONS: This study demonstrates the major burden of transfusions in patients with LR-MDS, both in terms of public health and the economic impact for health insurance in France. The analysis was performed using an exhaustive database to ensure highly representative results. Resource utilization from an NHI perspective illustrates precisely the economic burden caused by transfusions and their complications. Nevertheless, the causality between transfusion and hospitalization related to transfusion complications cannot be established fully with PMSI-MCO data.