OBJECTIVES To Evaluate the cost-effectiveness of four interventions (Interferon-á (IFN), Sunitinib, Bevacizumab+IFN, Sorafenib) approved as first-line treatment for mRCC in Colombia. METHODS A Markov model was developed using 6-week cycles from a third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or best supportive care (BSC). Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in 4 cities. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. RESULTS Sunitinib treatment was associated with a gain in life years (LY) saved, the Incremental cost analysis indicated a difference of 41.1 million Col$ (19,773 USD) in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing Sorafenib and Bevacizumab+INF to Sunitinib demonstrated that the average total cost was less for the Sunitinib by 8.3 (3,991 USD) and 104.2 million Col$ (50,155 USD), respectively. Additionally, the ICER by life years (LY) gained demonstrated Sunitinib's simple dominance over Sorafenib and the combination of Bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ (48,362 USD) compared to IFN. CONCLUSIONS Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia.