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Background: Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce. Methods: We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay. Results: Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R2 = 0.334) of the hospitalisation time and 79.3% (R2 = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; β = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria). Conclusion: Transfusion without following WHO recommendations increased the time and cost of hospitalisation. [ABSTRACT FROM AUTHOR]