OBJECTIVES: Few studies regarding the head-to-head cost-effectiveness analysis of medications treating for Alzheimer’s Disease have been conducted in Asia. The goal of this study is to perform a comparative assessment of donepezil and rivastigimine on the costs and efficacy of mild to moderate AD patients.  METHODS: A four-state Markov model was built to simulate the disease progression of the mild to moderate AD patients’ life span (from sixty five years of age to death). Transition probabilities between states and the cost of medical treatments at different stages derived from the local data in Taiwan. Analyses were run to evaluate outcomes for patients with mild AD from societal perspective. While all cost outcome have been discounted at 3% per annum. RESULTS: The result of the Markov cohort simulation shows that for the life expectancy in the long-term, rivastigmine treatment is the dominant strategy as it is more effective and economical than the alternatives. Specifically, treating patients with rivastigmine, compared with no treatment, yielded a 0.34 quality-adjusted life years (QALYs) increase per patient over the life time. Furthermore, the average cost savings per patient favored rivastigmine by resulting in US$10,503 from the societal perspective (2012 USD). For the donepezil versus rivastigmine base-case comparison, patients on donepezil gained 0.64 QALYs. Cost savings for the donepezil group were US$50,312 from the societal perspective. CONCLUSIONS: It is concluded that donepezil and rivastigmine are the two medical treatments that might be a cost saving strategy for mild or moderate AD patients in Taiwan from the societal perspective.