OBJECTIVES: To evaluatie simultaneously frequency of occurrence, outcomes, and cost of care of renal cell carcinoma (RCC), in order to provide empiric evidence on the burden of RCC. METHODS: Retrospective, naturalistic longitudinal study based on claims of individuals enrolled in the Friuli Venezia Giulia (FVG) administrative database. Since 1980, all FVG inhabitants are registered in an administrative database which includes information on hospital admissions, outpatients care, pharmaceutical prescriptions and mortality. We selected residents of FVG who had a RCC first hospital admission (ICD9 code 189) during the period 2000-2004, and we followed them up until: June 30, 2005, death or transfers. Direct medical costs (hospitalizations, drugs, visits, diagnostics and laboratory exams) were quantified using prices or tariffs expressed in Euro 2005. The perspective of FVG Regional Health Service was adopted. Survival and costs analysis were performed considering the presence or the absence of metastases. RESULTS: We enrolled 1358 patients (63% male), the 18.8% representing a metastatic-stage, leading to a crude incidence of  23/100,000 person-years. During follow-up, 76% of the metastatic patients and 21% of the non metastatic patients died. The risk of death was significantly higher among metastatic stage patients with a median survival of about six months. The cost per patient related to the first year after diagnosis for subjects with and without metastases was €13,692 and 10,502 Euro, respectively, with a mean difference of 3,363 Euro after adjusting for age and sex. Total health care costs per-patient over the maximum of follow-up were €16,090 for the localized-stage group and €17,656 in the metastatic-stage group. CONCLUSIONS: Results from our study show that, due to the large number of hospitalizations and the high mortality, the epidemiologic and socioeconomic burden to the health care system and to the society of RCC is high.