OBJECTIVES: Sunitinib is one of the first targeted treatments for metastatic renal cell carcinoma (MRCC) and is currently considered as the standard of care for most of the MRCC patients in the first-line setting. Sunitinib delays disease progression, with a median overall survival of more than 2 years, improves quality of life and is becoming the first-line standard of care for MRCC. The introduction of targeted treatments, led to improvements in disease management and survival of these patients, however, with increasing cost. Purpose this reserch - to assess the economic value of sunitinib as first-line therapy in MRCC within the Kazakh healthcare system. METHODS: Cost-effectiveness of sunitinib has been assessed on several occasions and a systematic literature search was conducted to find all published research articles as well as all research abstracts presented in various congresses. An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line MRCC therapy from the Kazakh perspective. RESULTS: Progression-free survival and overall survival data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually approximate 3%, were obtained using deterministic and probabilistic analyses. Sunitinib was more effective and less costly than both SFN and BEV/IFN  with average cost savings/patients, respectively. Using a willingness-to-pay threshold, sunitinib achieved an incremental net benefit compared with SFN and BEV/IFN, respectively. At this willingness-to-pay, the probability of sunitinib providing the highest incremental net benefit was 72%. CONCLUSIONS: Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line MRCC therapy in the Kazakh healthcare setting.