The burden of disease associated with unsafe therapeutic injection practices in Pakistan is very high. The number of injection per person per year has been estimated to be in the range of 8.2 to 13.6, one of the highest in developing world. Extrapolating this number to the whole country would result in 1.5 billion injections per year. Approximately 4% (75 million) of these are administered for immunization while the remainders are used for therapeutic use. Of these, 94.2% are unnecessary. Average price of an injection (not the complete prescription) is Rs. 20.6 (0.34 US dollars). Under conservative estimate, over three billion rupees or 500 million dollars out-of-pocket healthcare resources may be wasted each year. Appropriate use of injections would be highly cost effective. According to adjusted analysis, safe and appropriate use of injection in Pakistan would cost 92 million US dollars each year with a high proportion that would be injection devices paid through out-of-pocket expenses. Behaviour change for reduction in number of injections require long-term multidimentional efforts. Interventions in the form of phasing out of convention disposable injection equipment and switching to reuse prevention devices for all injections could prevent the common practice of reuse, hence reducing the transmission of infections.