OBJECTIVES: Elaborate an economic evaluation based in a cost-effectiveness model to compare sunitinib versus interferon-α (IFNα) and bevacizumab + IFNα as first line therapy for metastatic renal clear cell carcinoma, in Brazilian Private Health System perspective. METHODS: A Markov model, with 6 weeks cycles and a 2-year time horizon was developed in Microsoft Excel to evaluate the cost-effectiveness of sunitinib vs. IFNα and bevacizumab + IFNα, considering resources from the Brazilian Private Health Care. The model considered that the patients received active treatment until drug fail. After progression confirmation, patients were treated with a second line of active treatment or best supportive care (progression monitoring and palliative treatment). Results were expressed as life-years (LY) gained, progression-free LY (PFLY) gained, treatment costs, and incremental cost-effectiveness ratios (ICER) RESULTS: In comparison with IFNα, sunitinib increases LY and PFLY by 0.08 and 0.33 years respectively, with ICER of R$324,172 (US$190,689 Purchasing Power Parity 2009, 1US$=1,7R$). In comparison with bevacizumab + IFNα, sunitinib was dominant as both more effective (with 0.04 LY and 0.09 PFLY gained) and less costly, with a negative ICER of R$ 2,169,212 (US$ 1,549,437) over 2 years, meaning a cost saving of R$ 2,169,212 over the combination therapy. CONCLUSIONS: This model suggests that when taking the perspective of the Brazilian Private Health Care System , sunitinib achieved overall cost saving with improved survival when compared with bevacizumab + IFNα in a 2 years time horizon. In comparison to IFNα, sunitinib promoted better results on efficacy parameters, with an incremental cost in the same time horizon.