Aim. To conduct a health economic evaluation of everolimus and axitinib in patients with metastatic clear cell carcinoma. Material and methods. The cost-effectiveness analysis, budget impact analysis and sensitivity analysis were per- formed. Progression-free survival and overall survival were included into the model as the effectiveness criteria. All the direct costs were calculated from the healthcare system per- spective.Results. Treatment with everolimus was associated with lower direct costs, less frequent adverse events and longer overall survival compared with axitinib. Total costs per patient were 1 686 463 RUR and 2 283 237 RUR for everolimus and axitinib, respectively. A sensitivity analysis confirmed the base case results. Budget Impact Analysis showed that everolimus use allows to save budget costs and to treat addi- tional patients without spending healthcare resources. Conclusion. We found that the use of everolimus is cost- effective as it is characterized by lower costs and higher effi- cacy compared with axitinib.