OBJECTIVES: Cost-effectiveness of pazopanib versus sunitinib in Egyptian patients with metastatic renal cell carcinoma has not yet been established. The aim of the present study was to evaluate the cost-effectiveness of pazopanib versus sunitinib in Egyptian patients with metastatic renal cell carcinoma over a ten-year period from the perspective of the health insurance.  METHODS: A cohort Markov chain model with three health states (first line until progression, progression, and death) based on Egyptian clinical practice was derived from published sources. The length of a cycle was set at six weeks. The clinical parameters were derived from randomized trial previously published. The quality of life of the health states was derived using the available published data. Direct medical costs were obtained from the health insurance tariff in Egypt. All costs and effects were discounted at 3.5% annually. All costs were reported in Egyptian pounds of the financial year 2013. RESULTS: The total quality-adjusted life-years (QALYs) of pazopanib was estimated to be 725 and that for sunitinib was 674, which resulted in a difference of 51 QALYs. The total costs for pazopanib and sunitinib were EGP 2,692,116 and EGP 3,712,660, respectively (the difference was -1,020,543), which yielded an incremental cost-effectiveness ratio of EGP -19,946/QALY. Thus, pazopanib was superior. Various one-way sensitivity analyses indicated that the overall survival medians of both drugs had the greatest effects on the results. CONCLUSIONS: The present study concludes that, from the perspective of the health insurance, pazopanib is more effective and less costly than sunitinib for patients with metastatic renal cell carcinoma. This model addresses both the health and economic implications of both drugs. These results suggest that pazopanib is the superior therapy. This study helps to inform decisions about the allocation of health care system resources and to achieve better health in the Egyptian population.