OBJECTIVES: To assess the economic impact of oral nutritional supplements (ONS), being a medical nutrition product, in elderly patients in the ambulatory setting  from the society perspective in Germany in 2009. METHODS: This health economic analysis is based on a comparison of the use of ONS versus “no ONS” in elderly (>65 years) patients in the ambulatory setting who are eligible for ONS due to disease-related malnutrition (DRM). The costs of the two treatment strategies ONS versus “no ONS” were assessed using a linear decision analytic model reflecting costs related with DRM. The model structure allowed for differences in costs for ONS, consultations and hospitalization costs. Clinical probabilities and resource utilization were based on clinical trials and published literature; cost data were from official price tariffs. RESULTS: The use of ONS reduces the total costs from €1376 to €1197, which corresponds with a €179 cost savings per patient. The additional costs of ONS are more than balanced by a reduction of consultations and hospitalization. Sensitivity analyses were performed on all parameters, including cost of hospitalization and improvement of DRM. These results showed that the use of ONS in all sensitivity analyses leads to cost savings. The use of ONS would lead to an annual cost saving of €344 million based on the number of 1.9 million malnourished elderly in Germany. CONCLUSIONS: This health economic analysis shows that the use of ONS in eligible elderly patients in the ambulatory setting leads to a positive economic impact in Germany.