Alzheimer's disease (AD) is an important and rapidly expanding public health problem. Its large economic burden is a result of its disabling nature, chronicity, and high prevalence in older segments of the population. Current treatments of AD have been criticized for providing insufficient benefit to justify their costs, but variability in assessing both costs and benefits make evaluation of the existing data problematic. Inclusion of the value of caregiver time is a major driver of the determination of cost-effectiveness. Population-based studies and those based on application of economic models to other study outcomes tend to identify greater cost-effectiveness than prospectively collected data. Differences in healthcare economics across countries also limit generalization of specific study findings. The current state of evidence suggests that treatment decisions in AD should be based on assessment of benefit in individual patients rather than broader societal economic factors. © 2008 Dove Medical Press Limited. All rights reserved.