OBJECTIVES: IV catheterization is the most common invasive procedure among hospitalized patients and the widest practiced to prevent complications is routine replacement of the catheter (RCC) in fixed intervals. A meta-analysis (Webster 2008) showed no significant differences in terms of efficacy from RCC and replacement only when clinically indicated (RCI). This study aims to compare costs and consequences of RCC versus RCI from the public payer perspective. METHODS: Efficacy data was obtained from Webster 2008 which showed no clinical benefits of RCC over RCI. Data from the Brazilian Hospital Information System (SIH/DATASUS) from January 1 - December 31, 2009 was used to define the annual number of admissions of adult patients in public hospitals wards, assuming RCC as the current practice (no ICU patients included). The mean length of stay (LOS) and the mean time to replacement (TTR) were used to calculate the number of replacements in each scenario. Resource utilization was estimated through published data and unit costs were obtained from Brazilian official price lists. RESULTS: A total of 8,985,758 hospitalizations were identified in the database in 2009 with mean LOS of 5.53 days (132.66 hours). According to a published randomized clinical trial included in Webster 2008, mean TTR for RCC and RCI was 66.5 and 90.6 hours, respectively, resulting in average 1.99 and 1.46 replacements per hospitalization in each setting. The estimated cost of replacement was 2.54BRL (nursing time and medical supplies). For all admissions, the total cost for RCC and RCI was 45,556,510BRL and 33,438,277BRL. The estimated savings were 12,118,232BRL/year for the public health care system or 1,348BRL/year per 1,000 admissions. CONCLUSIONS: RCI has shown similar efficacy when compared to RCC with fewer costs. The cost difference was mild in magnitude but when extrapolated to a large-scale perspective these results reinforce the need of evidence-based decision making and rational resource allocation.