OBJECTIVES: Patients undergoing HCT are at risk for infections, especially dsDNA viral infections (cytomegalovirus, BK Virus, Epstein-Barr Virus, HHV-6, herpes simplex, herpes zoster, and adenovirus), for which there are limited viable preventative pharmacotherapies. Our objective was to compare direct medical costs reimbursed by health insurers following HCT for patients with dsDNA viral infection versus those without infections. METHODS: MarketScan Research Databases were used to identify patients with a first (index) procedure code for HCT between 01-July-2009 and 30-June-2014. Eligible patients were required to have 365 days of health plan enrollment prior to HCT to understand baseline factors. Reimbursements were tabulated for up to 365 days post-transplant; univariate Wilcoxon tests compared reimbursements for patients with at least one dsDNA infection versus patients with no dsDNA infection. RESULTS: The cohort included 6,553 HCT patients with no dsDNA viral infection (2,111 [32%] allogeneic, 4,442 [68%] autologous) and 1,275 patients with at least one dsDNA viral infection (924 [72%] allogeneic, 351 [28%] autologous). Mean (SD; IQR) reimbursements for the 365 days post-transplant were $218,151 (SD=$209,717; IQR=$94,873-$276,992) for HCT recipients without dsDNA infections versus $470,784 (SD=$467,557; IQR=$193,854-$588,019; p=0.0001) for those with any dsDNA viral infection. Among allogeneic HCT recipients, reimbursements were higher. Mean (SD; IQR) costs post-transplant for allogeneic HCT recipients without infection were $320,320 (SD=$278,388; IQR=$ 53,191-$405,450) versus $551,664 (SD=$503,913; IQR=$261,318-$654,483; p<0.0001) for patients with any dsDNA viral infection and $999,010 (SD=$822,223; IQR=$449,033-$1,410,000) for patients with adenovirus infection. Adenovirus infection represented 4.5% of all dsDNA viral infections. CONCLUSIONS: Patients who experience dsDNA viral infection following HCT have a higher burden of reimbursement compared to those without such infections. dsDNA virus infections are most common and more costly in allogeneic HCT recipients. Measures to prevent dsDNA viral infection following HCT could result in cost savings and improved patient outcomes.