OBJECTIVES: To determine the economic implications of agents used to treat metastatic renal cell carcinoma (mRCC).  METHODS: A life-time Markov model was developed to simulate the patterns of disease progression and to determine the outcomes under treatment of available medicines including interferon-alpha (IFNa), sunitinib, sorafenib, and bevacizumab.  Costs were measured based on the perspective of a health care provider. Resource utilization derived from retrospective chart reviews of 14 mRCC patients treated at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Costs and survival benefits were discounted annually at 3%.  RESULTS: The major assumption of the study was that the projected PFS and overall survival were longer for sunitinib than the other comparative treatments based on results of published studies. Additional treatment after failure of one tyrosine kinase inhibitor (TKI) in the model was limited which fit well with the practical scenario in developing country. Cost-effectiveness analyses demonstrated that IFNa had the most favourable cost-effectiveness ratio at 1.3 Million Baht/QALYs followed by sunitinib, sorafenib, and bevacizumab at 1.7, 1.9, 9.3 Million Baht/QALYs respectively. However, sunitinib had a better incremental cost-effectiveness ratios (ICERs) over IFNa at 2.0 million Baht/PFY,  2.7 million Baht/LYG, and 3.6 million Baht/QALY gained. Sensitivity analysis showed that the most sensitive parameters for sunitinib were the overall survival efficacy and costs. CONCLUSIONS: Our study reveals that sunitinib has the good cost-effectiveness profiles as one of the first line treatment of mRCC. With current study model, it may be applicable to the situation in developing country with limit availability of TKIs in the treatment of mRCC. However, sunitinib’s ICER comparing to IFNa is still beyond the ICER threshold for a developing country. This cost-effectiveness evidence should be taken into account in conjunction with other clinical, societal and ethical considerations in the treatment of mRCC.