Dad, I saved you $200 today." Despite such sincere and enthusiastic claims, I have never once found more money in my wallet. In this issue of the Archives, Ernst et al1 present a thoughtful potential cost-savings analysis of treatment for Alzheimer disease that temporarily stabilizes or reverses cognitive decline. Based on the assumptions used in their model, the magnitude of potential savings seems reasonable.
Cost-savings analyses, however, are by their very nature double-edged swords. Results often can be easily turned around. For example, would Ernst et al, patients and their families, and the pharmaceutical industry all agree that an Alzheimer disease medication that prevented a 2-point decline over 1 year on the Mini-Mental State Examination, but cost $3700, not be given because it was not cost-effective? When considering cost-savings analyses, remember that better models and "smarter bean counters" always exist. Pointing out weaknesses in cost-savings analyses often is easy.
Riggs JE. On the Nature of Cost-Savings Treatment Analysis. Arch Neurol. 1997;54(6):683. doi:10.1001/archneur.1997.00550180009005