OBJECTIVES: Everolimus and sunitinib are indicated to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). This analysis examines the projected cost-effectiveness of everolimus versus sunitinib in this setting from a Swedish payer’s perspective. METHODS: A lifetime Markov model was developed to simulate a cohort of advanced, progressive pNET patients to estimate the incremental cost-effectiveness when treating with everolimus (10 mg/day) versus sunitinib (37.5 mg/day). Efficacy inputs were based on a weight-adjusted indirect comparison of the therapies using the respective phase 3 trial data (Signorovitch et al. 2013 and data on file). The disease pathway is reflected through mutually exclusive health states: stable disease without adverse events, stable disease with adverse events, disease progression, and death.  Unit costs were obtained from public official Swedish sources. The model includes only direct costs. Resource use was based on a German physician survey, validated and adapted to Swedish conditions. Costs were represented in 2014 Swedish Krona (SEK). The incremental cost-effectiveness ratio (ICER) was calculated.  Two-way sensitivity analyses were conducted to test the model’s robustness. RESULTS: In the base case, the estimated gain of everolimus over sunitinib was 0.357 LYs (0.261 QALYs), which results in an ICER that ranges from 100,000 -200,000 SEK/QALY depending on the assumptions around the duration of therapy for active treatment. The analysis is sensitive to the uncertainty of the indirect analysis results and variables such as dose intensity. CONCLUSIONS: This model, based on an indirect comparison of phase 3 studies, indicates that everolimus is cost-effective relative to sunitinib in advanced pNET.  Its reliance on an indirect analysis due to the lack of head-to-head randomized controlled trial data warrants future research; however, model results indicate that everolimus is a valuable treatment option for pNET patients in Sweden.