OBJECTIVES: Renal Cell Carcinoma (RCC) is the most common type of kidney cancer. Its incidence has increased rapidly in China in recent years. Targeted therapy is the main treatment option for metastatic RCC(mRCC). The objective of this study is to estimate and compare the cost of different sequential treatment regimens for mRCC from a Chinese payer’s perspective. METHODS: A cost analysis was performed to assess the health care costs of all possible treatment sequences from the perspective of National Health Insurance in China. The base case sequential treatment regimens included: 1) sunitinib as 1st-line (1L), axitinib as 2nd-line (2L) and everolimus as 3rd-line (3L) (SuAE); 2) sunitinib as 1L, sorafenib as 2L and axitinib as 3L (SuSoA);  3) sunitinib as 1L, everolimus as 2L and sorafenib as 3L (SuESo). The medication costs were derived from databases of Ministry of Health and insurance organizations. Current patient assistance programs for sorafenib, sunitinib and axitinib in China were incorporated by applying the relevant cost discounts. Treatment duration(estimated based on progression-free survival), cost and incidence of AEs by treatment line were obtained from the literature. Cost per patient per month (PPPM), cost per patient were calculated for each treatment sequences. RESULTS: When sunitinib was used as 1L, axitinib as 2L and everolimus as 3L(i.e.,SuAE), the PPPM cost was ¥15,106, which was lower than the SuSoA(¥18,824) or SuESo(¥20,479) regimens. The total treatment duration for SuAE was 21.4 months, slightly shorter than SuSoA (21.7 months) and longer than SuESo (18.3 months).The total regimen cost per patient was ¥322,714 for SuAE , ¥408,253 for SuSoA, and ¥374,892 for SuESo.  CONCLUSIONS: This study suggests that adding axitinib to treatment strategy as 2L following sunitinib may lower total treatment regimen costs in mRCC from the Chinese National Health Insurance payer’s perspective.