OBJECTIVES: Targeted therapies shows marked clinical improvements over standard treatments such as interferon alfa (IFNa) in the treatment of advanced/metastatic renal cell carcinoma (mRCC). We report an updated cost-effectiveness analysis of pazopanib, sunitinib, and bevacizumab (the later associated INFa) as first line treatments for mRCC under the Brazilian public healthcare perspective. In previous analysis, taxation was accounted exclusively for pazopanib’s price.[Value Health 2012;15(4):A218] The present analysis applied ex-factory 0% tax prices, where now all comparisons were made under tax waiver programs. METHODS: A Markov model was designed to simulate mRCC progression, mortality and costs. The assessed time-horizon was 2 years. An indirect comparison estimated the relative efficacy and safety of the targeted therapies in mRCC patients. Costs and consequences of disease treatment were computed for each comparator. Only direct medical costs were considered and reported in 2013 Brazilian currency (1BRL=0.50USD). Drug prices derived from official price list (i.e., CMED). Disease management costs were those from a public reimbursement database (i.e., SIGTAP). Costs and outcomes were discounted at 5% yearly. Outcomes assessed were progression-free survival (PFS) and quality-adjusted life years (QALYs). Stochastic simulations tested model robustness. RESULTS: The indirect PFS hazard ratio (<1 favours pazopanib [95%CI]) indicated that pazopanib is not statistically different from sunitinib (0.93 [0.56, 1.56]) or bevacizumab+IFNa (0.79 [0.48, 1.32]). A recent head-to-head clinical study (COMPARZ) of pazopanib versus sunitinib confirmed indirect results. Estimated costs and QALYs were BRL 93,389.88 and 0.90 for pazopanib, BRL 124,923.36 and 0.93 for sunitinib, and BRL 185,942.43 and 0.88 for bevacizumab+INFa. Propabilistic analysis showed favourable economic results to pazopanib in >90% of simulations when compared to sunitinib. Bevacizumab+INFa was dominated in all scenarios. CONCLUSIONS: Pazopanib reported significantly lower costs and similar benefits against studied comparators as first line treatment of patients diagnosed with mRCC under the Brazilian public healthcare perspective.