From Grants to Patients: The Financial Anatomy of Alzheimer’s Treatment

In contemporary medicine, discussions around care are rarely detached from those about money. Whether in policy debates or scientific publications, “funding” is a recurring word. Alzheimer’s disease (AD), the most common cause of dementia, provides a particularly stark lens through which to examine this relationship. Affecting over 7 million people in the U.S. in 2025 (Alzheimer's Association, 2025), AD imposes immense clinical and economic burdens. How do patients navigate between effective treatment and cost-efficiency? And how do the financial incentives behind treatments affect clinical decision-making?

Research into Alzheimer’s disease is a multi-billion-dollar industry, with governments and pharmaceutical companies investing billions to understand and mitigate the disease’s effects. Since the passage of the National Alzheimer’s Project Act (NAPA) in 2011, annual funding for Alzheimer’s research through the National Institutes of Health (NIH) is projected to reach $3.9 billion by 2026 (Alzheimer’s Association, 2025b). However, one of the five core goals of the 2012 National Plan, to “prevent and effectively treat Alzheimer’s disease and related dementias by 2025”, remains unmet. The failure rate of AD drug development was 99.6% from 2002 to 2012 (Drug Discovery Trends Editor, 2014), underscoring the deep disconnect between investment and clinical outcomes. 

According to Cummings et al. (2018), the total cost of an AD drug development is estimated at $5.6 billion and spans approximately 13 years from preclinical studies to FDA approval. Compared to cancer treatment development estimated at $793.6 million per agent, AD drug development is substantially more costly. This disparity highlights the challenges of translating funding into tangible therapeutic progress.

Three main pharmacological treatments are commonly used for Alzheimer’s: galantamine, memantine, and lecanemab. Each represents a different balance of clinical benefit, adverse reactions, and economic cost. 

Galantamine, marketed as Reminyl, is an acetylcholinesterase inhibitor prescribed for mild to moderate Alzheimer’s. It costs roughly $1,200 annually per patient (Suh et al., 2008). Studies show it can modestly improve cognition and delay functional decline (Onor et al., 2007), yet 46% of galantamine-treated patients reported gastrointestinal adverse effects (Jones et al., 2004). 

Memantine, on the other hand, targets glutamate activity in the brain and is used for moderate to severe Alzheimer’s. It is slightly more expensive at around $1,900 per year but offers only limited cognitive improvement (Tampi & Dyck, 2007). It shows the best profile of acceptability, but comes with serious risk if you do not take it as prescribed, as symptoms often worsen quickly (Blanco-Silvente et al., 2018).

Lecanemab, a monoclonal antibody targeting amyloid-beta plaques, is the most recent innovation and is deemed the most successful in slowing clinical decline from AD. In a Phase 3 trial, lecanemab slowed the rate of cognitive decline by 27% over 18 months among participants with early-stage AD. It also exhibited lower rates of adverse reactions, with 21.3% of patients who received lecanemab having an incidence of adverse events (Hodes, 2023). However, it has the most severe adverse reaction as it often results in amyloid-related imaging abnormalities, which may cause blood vessel leakiness leading to localised brain swelling and bleeding in the brain. Moreover, the treatment alone costs $26,500 per year (Grabowski & Rosenbloom, 2023). 

Despite such high drug prices, the cost for medication only accounts for 5% of the total cost of care for treated Alzheimer’s patients, with the overall economic burden of dementia in the U.S. reaching $781 billion, including quality of life loss and informal and medical care (Rika Kanaoka, 2025). Two-thirds of these costs are borne by patients and families, often through unpaid labor or selling property to pay for care. 

While drugs like galantamine or lecanemab aim to slow disease progression, they are not always effective and further expose socioeconomic inequalities embedded within the healthcare system. The pharmaceutical industry’s reliance on patent-based revenue models and high launch prices exacerbates the divide between scientific advancement and equitable access. The hidden economy of medicine ensures that financial pressures remain central to clinical outcomes. 

From the laboratory to the bedside, money moves silently through every stage of medicine. While drugs like galantamine, memantine, and lecanemab offer measurable, or at times modest, clinical benefits, their costs raise the question of how we can sustain innovation without commodifying care. The hidden economy of medicine is not inherently malevolent: grants fund lifesaving discoveries, and pharmaceutical profits support future research. Yet the structure of modern healthcare often hides the ethical trade-offs that accompany financial incentives. To navigate these tensions, healthcare must be more financially transparent, prioritize equitable access, and redefine value beyond profit and productivity.

Reviewed by: Anjali Reddy

Designed by: Poorvaja Chandramouli

References:

Alzheimer's Association. (2025a). Alzheimer’s Disease Facts and Figures. Alzheimer’s Disease and Dementia; Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures

Alzheimer's Association. (2025b, July 31). $100 Million Increase Approved for Alzheimer’s Research | alz.org. Alzheimer’s Association; Alzheimer’s Association. https://www.alz.org/news/2025/senate-appropriations-committee-approves-100-million-increase-alzheimers-research

Blanco-Silvente, L., Capellà, D., Garre-Olmo, J., Vilalta-Franch, J., & Castells, X. (2018). Predictors of discontinuation, efficacy, and Safety of Memantine Treatment for Alzheimer’s disease: meta-analysis and meta-regression of 18 Randomized Clinical Trials Involving 5004 Patients. BMC Geriatrics, 18(1). https://doi.org/10.1186/s12877-018-0857-5

Cummings, J., Reiber, C., & Kumar, P. (2018). The price of progress: Funding and financing Alzheimer’s disease drug development. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4, 330–343. https://doi.org/10.1016/j.trci.2018.04.008

Drug Discovery Trends Editor. (2014, July 7). 99% of Alzheimer’s Drug Trials Fail, Study Says - Drug Discovery and Development. Drug Discovery and Development. https://www.drugdiscoverytrends.com/99-of-alzheimers-drug-trials-fail-study-says/

Grabowski, T. J., & Rosenbloom, M. (2023, July 7). What the FDA Approval of Lecanemab Means for Patients and Families: A Q&A with MBWC Clinicians - Memory and Brain Wellness Center. Depts.washington.edu. https://depts.washington.edu/mbwc/news/article/lecanemab

Hodes, R. J. (2023, July 6). NIA statement on report of lecanemab reducing cognitive decline in Alzheimer’s clinical trial. National Institute on Aging. https://www.nia.nih.gov/news/nia-statement-report-lecanemab-reducing-cognitive-decline-alzheimers-clinical-trial

Onor, M. L., Trevisiol, M., & Aguglia, E. (2007). Rivastigmine in the treatment of Alzheimer’s disease: an update. Clinical Interventions in Aging, 2(1), 17–32. https://doi.org/10.2147/ciia.2007.2.1.17

Rika Kanaoka. (2025, April 23). The Cost of Dementia in 2025 - April 23, 2025 - USC Schaeffer. USC Schaeffer. https://schaeffer.usc.edu/research/the-cost-of-dementia-in-2025/

Suh, G.-H., Jung, H. Y., Lee, C. U., & Choi, S. (2008). Economic and Clinical Benefits of Galantamine in the Treatment of Mild to Moderate Alzheimer’s Disease in a Korean Population: A 52-Week Prospective Study. Journal of Korean Medical Science, 23(1), 10–10. https://doi.org/10.3346/jkms.2008.23.1.10

Tampi, R. R., & Dyck, C. H. van. (2007). Memantine: efficacy and safety in mild-to-severe Alzheimer’s disease. Neuropsychiatric Disease and Treatment, 3(2), 245–258. https://doi.org/10.2147/nedt.2007.3.2.245