OBJECTIVES: Alzheimer’s disease has a substantial economic impact on patients, their caregivers and society. There are four cognitive enhancers commonly used in the treatment of Alzheimer’s disease: three cholinesterase inhibitors (donepezil, rivastigmine and galantamine) and one NMDA receptor antagonist (memantine). Studies have indicated that the cost of cholinesterase treatment may be offset by savings in other health care costs. METHODS: The cost of medication on the South African market for Alzheimer’s disease was analysed using June 2014 retail prices with the Defined Daily Dose (DDD) as unit cost indicator. A retrospective drug utilisation study was conducted on prescription data of a medical insurance scheme administrator for 2012. RESULTS: The cost per DDD for memantine was R26.20 (20 mg, two 10 mg tablets). For rivastigmine, the cost was R41.02 per DDD and for galantamine R27.72 per DDD (using the most convenient dosage strengths). These three products were all originator products. For donepezil, the originator and three branded generics were available. The cost of the originator was R27.86 per DDD, and for all three generics R16.29 per DDD. Only 32 patients were included in the drug utilisation study since not all medical aids reimburse these products. The average age of patients was 74.17 (SD=9.54) years, with 50% females. Only memantine and donepezil were prescribed. Donepezil accounted for 77.48% of prescriptions (of which 60.93% were generic prescriptions). The average Prescribed Daily Doses (PDDs) were 16.30 (SD=4.92) mg for memantine and 8.73 (SD=2.84) mg for donepezil. The most frequent PDDs for memantine was 20 mg (62.96% of prescriptions) and 10 mg (37.04% of prescriptions), and for donepezil 10 mg (65.96% of prescriptions) and 5 mg (29.79% of prescriptions). CONCLUSIONS: More South African studies on Alzheimer’s disease treatment cost are needed that include the stage of the disease and adherence to treatment.