OBJECTIVES: Medical treatment for mRCC during 2002 represented around 4% of the resources designed for cancer treatment in Colombia; a local study has shown that Sunitinib (SU) was the most cost-effective medication for first-line treatment of mRCC. We evaluated the budgetary impact of including SU as choice for first-line treatment of mRCC compared to the current treatment being offered in Colombia (Interferon-á (IFN), Bevacizumab+IFN and Sorafenib). METHODS: Sunitinib's budgetary impact was estimated including mRCC patients which were candidates to receive first-line treatment under the SGSSS, using a 5-year time horizon. A Markov model was developed to predict costs simulating disease progression. Data regarding frequency of use and health service cost units consumed was taken from a series of 24 patients treated in four different cities. Service costs corresponded to the average value billed by the HMOs, calculated from 33 sources of information which were representative of the country's market. The 5-year projected profile for the current treatment of patients suffering from mRCC was estimated starting from each medication's market share and then compared to a scenario of changing Sunitinib's share to being 100%. The measures of effectiveness applicable for the projection were taken from previously-published clinical trials. A One-way sensitivity analysis was conducted for validating the model's robustness and costs are shown in Colombian pesos (Col$) (Exchange rate 1 USD = 1966.26 Col$). RESULTS: The total budgetary impact of SU as first-line treatment for mRCC represented a saving for the Colombian SGSSS of Col$ 2,038,197,489 during 2009, Col$ 2,215,421,548 in 2010, Col$ 2,068,559,499 in 2011, Col$ 1,923,678,137 in 2012 and Col$ 1,840,110,375 in 2013. This would represent an overall saving of Col$ 10,085,967,048 for the next 5-years. CONCLUSIONS: Including SU as the option of choice for first-line treatment of mRCC in the Colombian SGSSS would be favorable and cost-saving.