OBJECTIVES: Renal cell carcinoma (RCC) accounts for approximately 2% of all cancers worldwide. With the introduction of modern targeted therapies (TT) the prognosis of patients with metastatic RCC (mRCC) has improved, but the costs of drugs have also increased. We investigated the real world value of TT in the Swedish mRCC population by comparing survival and the cost of care over time. METHODS: Patients diagnosed with RCC 2002-2010 were identified in the Swedish Cancer Registry. A pre-defined algorithm was used to determine the presence of mRCC. Three cohorts of patients diagnosed with mRCC 2002-2005, 2006-2008 and 2009-2010 were compared. Data on resource utilization and survival was obtained through record linkage with national registries for prescription pharmaceuticals, inpatient- and outpatient care and cause of death. Survival was estimated using Kaplan-Meier methods. Expected resource utilization and costs were estimated using the Lin method to account for censoring. A sensitivity analysis was carried out to investigate, in more depth, the cost of hospital dispensed drugs. RESULTS: Mean survival in years from mRCC diagnosis for the 2002-2005 cohort (n=1,466) was 1.45; for the 2006-2008 cohort (n=1,158) 1.62 and for the 2009-2010 cohort (n=806) 1.77. Total costs over a period of 4 years were $16,894, $29,922 and $28,508, respectively. This resulted in an estimated ICER of $78,656 per LYs gained when comparing the 2006-2008 and 2002-2005 cohorts and $36,228 per LYs gained when comparing the 2009-2010 and 2002-2005 cohorts. When the 2009-2010 cohort was compared to the 2006-2008 cohort, the former was dominant. The sensitivity analysis showed an approximately 15% increase in total costs. CONCLUSIONS:  The study suggests that the real world value of TT in the Swedish mRCC population corresponds well to the investment made and that the value of invested money increases over time.