OBJECTIVES:  To assess the cost-effectiveness of Food for Special Medical Purposes (FSMP) for the prevention of malnutrition in patients undergoing abdominal surgery from the perspective of the society in The Netherlands. METHODS: The costs and benefits of the two treatment strategies were assessed using a linear decision analytic model reflecting treatment patterns and outcomes in abdominal surgery. The model structure allowed for differences in costs and length of stay. The incremental cost difference was based on costs associated with cost of FSMP and hospitalization. Clinical probabilities and resource utilization were based on clinical trials and published literature; cost data were from official price tariffs. RESULTS: The use of FSMP reduces the costs from €3318 to €3,066, which corresponds with a €252 (7.6%) cost savings per patient. The additional costs of FSMP are more than balanced by a reduction on hospitalization costs. The hospitalization costs reduce from €3318 to €3044 per patient, which is a 8.3% cost saving and corresponds with 0.72 days reduction in LOS. The use of FSMP would lead to an annual cost saving of €40.4 million based on the number of 160,283 abdominal procedures per year in The Netherlands. Sensitivity analyses were performed on all parameters, including length of stay and per diem costs. The results showed that the use of FSMP in all sensitivity analyses remain cost saving compared to “no use” of FSMP. A threshold analysis on the length of stay shows that at length of stay of 0.64 days, the use of FSMP is still cost-effective. CONCLUSIONS: The use of FSMP is a very cost-effective treatment in the Netherlands and is dominant over standard care without FSMP: cost savings and higher effectiveness.