OBJECTIVES: To assess the cost-effectiveness of sunitinib malate as a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with sorafenib and interferon-alfa (IFN-α) in the Chinese healthcare setting. METHODS: A Markov model was developed in Microsoft Excel® to simulate disease progression and determine outcomes over 5 years of a hypothetical cohort of 1,000 patients with mRCC receiving first-line treatment (in 6-week cycles, 4 weeks treatment plus 2 weeks off treatment) with sunitinib compared with sorafenib as well as IFN-α. The model parameters were derived from the Pivotal Study A6181034-A3, published literatures, government sources as well as clinical experts’ opinions. Only direct costs were considered in terms of drug treatment, routine follow-up, severe adverse events, disease progression, and costs of health care resources involved in the palliative care of terminally-ill patients. Health outcomes were measured in LYs and QALYs. The results were expressed as ICER and ICUR. Time horizon was 5 years and the discount rate of 5%/year was applied to costs and effectiveness. Sensitivity analyses were also performed. RESULTS: The results indicated that in terms of total average cost per patient over 5 years, sunitinb was less costly (￥611,054) than sorafenib (￥613,304), and more costly than IFN-α(￥150,159). Concerning health outcomes, the estimated gains for one patient treated with sunitnib over IFN-α were 0.25 LYs and 0.29 QALYs, and over sorafenib were 0.09 LYs and 0.13 QALYs. The ICER and ICUR of sunitinib versus IFN-α were ￥1,837,954 per LY gained and ￥1,585,357 per QALY gained, respectively. CONCLUSIONS: Results suggest that sunitinib has better clinical efficacy compared to sorafenib and IFN-α, and is a cost-saving alternative to sorafenib as a first-line treatment for mRCC in China. When compared with IFN, Sutent achieved better clinical outcomes with increased cost.