OBJECTIVES: Alzheimer's Disease (AD) is a public health emergency affecting the aging population in the US. By 2023, 6.7 million Americans 65 and older are estimated to have Alzheimer's. Pharmacological management of Alzheimer's includes inhibition of acetylcholinesterase and N-methyl-D-aspartate receptors. AChEIs like donepezil, galantamine, and rivastigmine treat mild and severe AD. Treatments for Alzheimer’s Disease are associated with different adverse events (AEs), which may be costly for payers. This study aims to calculate the patient level cost of managing AEs related to AD treatments, per treatment, treatment category, and discontinued AEs per treatment for all US FDA-approved drugs for AD as of May 31, 2023.

METHODS: Cost data for AEs treatment included drug acquisition, healthcare resource utilization, dosing schedules, and number of administrations from US FDA labels. Unit costs were taken from May 2023 Red Book™. Healthcare resource utilization and AE costs were from CMS office visits fee schedule and treatment costs from Red Book™.

RESULTS: The total cost of treating AEs per person per year for Galantamine is $36.4, Rivastigmine is $559, Donepezil (5 or 10 mg) is $35.1, Donepezil (23 mg) is $34.6, and Memantine is $59.5. The greatest cost for Immunotherapy Drugs is Aducanumab ($110.3), and the lowest is Lecanemab ($25.2). The total cost per class is Cholinesterase inhibitors ($665.1), N-methyl-D-aspartate (NMDA) antagonists ($59.5), and Immunotherapies ($135.5). The total cost of discontinuation due to AEs per person per year for Galantamine is $7.2, Rivastigmine is $35.2, Donepezil (5 or 10 mg) is $3.9, Donepezil (23 mg) is $6.5, and Lecanemab is $0.0.

CONCLUSIONS: Rivastigmine is the drug that has the greatest cost for treating AEs, while Lecanemab has the lowest cost.