OBJECTIVES: To estimate the cost-effectiveness of Galantamine in the extended release formulation for the management of Alzheimer's Disease (AD) versus other acetylcholinesterase inhibitors (Donepezil, Rivastigmine and Galantamine immediate release formulation) in Mexico. METHODS: A decision analysis was developed using a cost-effectiveness study, based on a Markov model, in order to understand the different stages of the disease over a period of 48 months. The databases of the Mexican Social Security Institute (IMSS) were consulted in a retrospective manner and a cohort of patients was used to determine the consumption of resources. The factors taken into consideration were: specific pharmacological therapy, outpatient consultation in family practice and specialty units, hospital stays, number of days hospitalized, emergency care and laboratory tests. To determine the effectiveness of each of the medications, a meta-analysis was carried out to compare clinical outcomes according to the ADAS-cog and CIBIC-plus scales. The different parameters of effectiveness were included in the model and consumption of resources also, with each therapeutic formulation. RESULTS: Galantamine ER was the alternative with the lowest annual cost of treatment, both in the highest recommended dose range ($43,162 pesos) as well as the lowest dose range ($28,214 pesos). Galantamine ER produced savings of $18,314 pesos in the highest dose range and $6,789 pesos in the lowest dose range versus Donepezil. Galantamine ER produced savings of $76,230 pesos and $20,274 pesos (highest and lowest recommended dose ranges, respectively) versus Rivastigmine; and $23,033 pesos and $18,559 pesos versus Galantamine IR. Galantamine ER revealed the lowest number of days hospitalized/year, a situation that is extremely relevant for the National Healthcare Institute. CONCLUSION: Galantamine ER is a dominant cost-efficient and cost-saving alternative for the management of Alzheimer patients in Mexico.