OBJECTIVES:  To develop an economic evaluation of cost-effectiveness of using Everolimus versus Axitinib for the treatment of patients with metastatic renal cell carcinoma, after they have progressed in the first-line treatment with pazopanib or sunitinib, in the Colombian context. METHODS:  Two Markov models were designed in quarterly cycles, with a time horizon of three years for a hypothetical cohort of 1 patient diagnosed with metastatic renal cell carcinoma, who have progressed on first-line treatment, one after using sunitinib and the other after using pazopanib. Second-line treatment technologies are everolimus versus axitinib. The analysis included the probabilities of second-line progression, progression-free survival and the adverse events the technologies can produce. The outcome evaluated was life years saved, in addition to the total costs for treatments. These costs were taken from Colombian health system information databases. The costs are showed in United States dollars, using current exchange rate to Colombian pesos. RESULTS:  According to the analysis, in terms of cost-effectiveness, the use of Everolimus has 0.11 life years more than Axitinib, with savings of US $ 2,586 if patients used pazopanib during first-line. If patients used sunitinib during first-line everolimus has 0.02 life years more than axitinib, with savings of US $ 2,508. Concluding that the cost of using everolimus treatment is less than using axitinib and effectiveness is greater compared to Axitinib. A sensitivity analysis using different discount rates was made, showing dominance in all the scenarios, the discount rates used were 0%, 3.5% and 10% CONCLUSIONS:  The use of Everolimus is a dominant option compared to Axitinib, in a time horizon of three years related to the treatment of patients with metastatic renal cell carcinoma in both models, which means, in patients who were treated in first line with pazopanib and patients who were treated with sunitinib in first line.