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In the first four years after diagnosis, patients in the very low IPSS-R category received on average 25 red cell (95% confidence interval, 20-32) and 4 (3-7) platelet transfusions. Conversely, patients in the very high-risk category received on average 171 (135-20 red cell and 66 (51-78) platelet transfusions. Correspondingly, transfusion costs ranged from $8805 ($6482-$11625) to $80106 ($61460-$95792). Transfusion count and costs for patients with MDS increased markedly with IPSS-R risk category, but were similar across age groups.