Abstract: Objective: To evaluate the cost-effectiveness of two different sequential therapies of sunitinib and sorafenib in the treatment of metastatic renal cell carcinoma. Methods: A Markov model was developed to simulate the disease progression and change in the treatments from a Chinese health care system and a 5-year time horizon was performed. The circle of the model was 6-week and the discount rate was set to be 3% in base scenario. Outcomes included costs, quality-adjusted life years(QALYs), progression-free life years(PFS) and overall survival(OS) life years. Model parameters were derived from published literature and cost survey data. Robustness was tested using probabilistic and deterministic sensitivity analyses. Results: Treatment of sunitinib as first line therapy plus sorafenib as second line therapy (SUSO) was associated with a gain in progression free life years of 0.56 and life years of 0.34 over sorafenib as first line therapy plus sunitinib as second line therapy (SOSU). Also, SUSO had more QALYs gained compared to SOSU (1.48 vs. 1.17), but at higher cost (438，383 Yuan vs. 306，240 Yuan). This resulted in an ICER of 437，870 Yuan. However, one-way sensitivity analysis showed that SUSO is cost effective when the time horizon is within 1 year. Conclusion: SUSO is unlikely to be cost effective compared with SOSU unless GDP per capita reaches $ 13700 on a 5-year time horizon. However, SUSO is associated with significant advantages in clinical outcomes. In terms of costs, other drugs other than sorafenib should be considered as alternatives in second line therapy if sunitinib failed in the first line therapy.