OBJECTIVES: To estimate the cost-effectiveness of sunitinib as first-line treatment for metastatic renal-cell carcinoma (mRCC) from the Colombian health system perspective. METHODS: A Markov model was developed to compare the quality-adjusted life-years (QALYs) of three strategies as first-line treatment for (mRCC): sunitinib (50 mg per day for 4 weeks followed by 2 weeks off-treatment), bevacizumab (10 mg/kg every 2 weeks) combined with interferon alfa-2a (9 MIU subcutaneously three times a week), and pazopanib (800 mg once daily). The efficacy, safety and utility data were taken from published studies. Bayesian mixed treatment comparison method was applied for the indirect comparison among treatments related to efficacy and safety. We used 5 years as time horizon. An annual discounted rate of 5% was applied. All currency units are in USD$ (1 USD$ = COP 2,640). Costs of drug treatment, disease progression and best supportive care were estimated using official tariffs and databases from Colombia.  We used as threshold three times the GDP per capita (USD$ 17,043). Results were tested using deterministic and probabilistic sensitivity analyses. RESULTS: The total expected costs per patient were: bevacizumab combined with interferon alfa-2a USD$ 65,302; sunitinib USD$ 62,074 and pazopanib USD$ 61,793. The results for each alternative in terms of QALY were: bevacizumab combined with interferon alfa-2a (1.62); sunitinib (2.28) and pazopanib (2.22). Bevacizumab combined with interferon alfa-2a was a dominated alternative. The ICER/QALY of sunitinib compared to pazopanib was USD$ 4,685. CONCLUSIONS: These results suggest that sunitinib as first-line treatment for (mRCC) is cost-effective in Colombia, taking into account the stablished threshold.