OBJECTIVES:  Conventional treatment of organophosphate (OP) poisoning with oximes has had limited success. Fresh frozen plasma (FFP), acting as a bioscavenger to clean up free OP has been recently proposed as a treatment. In this study, we undertook a meta-analysis to evaluate the efficacy of FFP in  management of OP poisoning to explore if this bioscavenger therapy can be effective and cost saving in health system or not. METHODS: All relevant databases were searched (till February 2012) for all clinical effects of FFP in OP poisoning. The inclusion criteria were death, development of intermediate syndrome, need for ventilation, and adverse effects. Cost data were collected from standard cost list. Cost-effectiveness grid of adding on FFP was calculated per consequence and compared with the conventional regimen. RESULTS: A total of 3 studies and 157 patients were included in the meta-analysis. Overall, we did not find significant effectiveness for FFP to prevent death (RR 1.01, 95% CI 0.32-3.4) or intermediate syndrome (RR 0.67, 95% CI 0.04-12.39). Since FFP in Iran is provided free of charge, the Δ cost is zero. Considering direct cost and clinically important differences between effectiveness of FFP supplementing and conventional therapy (Δ effectiveness (for avoiding intermediate syndrome) = 7), however economics evaluations is not necessary according to cost-effectiveness grid but it could be considered dominate. CONCLUSIONS: Results do not support significant efficacy of FFP in reduction of death or intermediate syndrome in patients with OP poisoning. FFP use, however, has no impact in health cost; by consideration of only direct costs; the possibility of its benefit in lowering rate of intermediate syndrome in terms of productivity loss and indirect cost should be considered in future studies.