Background: Avelulmab plus axitinib showed to improve clinical outcomes for patients with advanced renal cell carcinoma (aRCC) in the JAVELIN RENAL 101 trial. Several other immunocheckpints inihibitos (ICIs) options acquired a main role in the aRCC treatment, such as nivolumab plus ipilimumab and pembrolizumab plus axitinib. Our aim is to evaluate the cost effectiveness of avelumab/axitinib versus other FDA approved options for previously untreated patients with aRCC. Methods: A Markov model was used to estimate the costs and health outcomes of treatment of aRCC with sunitinib, or avelumab plus axitinib. Univariable and probabilistic sensitivity analyses were performed to determine the robustness of the model outcomes. The primary outputs of the model included the total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). Results: Avelumab plus axitinib provided and 4.77 additional QALY benefit. Total cost per patient was US$ 174,725 for avelumab/axitinib, US$ 178,725 for pembrolizumab/axitinib, US$ 169,390 for ipilimumab/nivolumab and US$ 97,846 for sunitnib. Avelumab/axitinib showed to be more cost-effective (ICER US$ 28,011/QALY) when compared to pembrolizumab/axitinib (ICER US$ 47,916/QALY) and ipilumumab/nivolumab (ICER US$ 95,392/QALY). Conclusions: Avelumab/axitinib is likely to be more cost-effective than ipilimumab/nivolumab, pembrolizumab/axitinib and sunitinib in the UK perspective. However further models, market discounts and stakeholders price negotiations could lead to variations of this scenario across the globe.