Objectives: Ablation is emerging as a safe alternative to surgical intervention for patients with early-stage renal cell carcinoma (RCC); however, its cost-effectiveness in Australia remains unclear. We performed a cost-effectiveness analysis to evaluate the relative clinical and economic merits of ablation compared to partial nephrectomy in treating early-stage RCC. Methods: A Markov state-transition model was constructed to simulate the progression of Australian patients with early-stage RCC treated with ablation versus partial nephrectomy over a 10-year horizon. Transition probabilities and utility data were sourced from a literature review, and cost data were estimated from the Australian health system perspective. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. Modelled uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. A willingness-to-pay (WTP) threshold of $50,000 per QALY was adopted. All costs are expressed in 2022 Australian dollars and discounted at 5% annually. We further adapted the findings to eight other high-income countries using a validated cost-adaptation method.Results: Both the base case and cost-adaptation analyses revealed that ablation was less costly but also less effective compared to partial nephrectomy over 10 years. The cost-effectiveness outcome was sensitive to the annual transition probabilities of developing local recurrence and distant metastasis. Probabilistic sensitivity analyses revealed that the model was robust to the overall effects of uncertainty, with ablation being cost-effective in only 23.0% of simulations at the designated WTP threshold.Conclusion: For early-stage RCC patients in Australia and comparable healthcare settings, resources are best allocated to partial nephrectomy if the goal is to maximize health benefits per dollar. Ablation remains a viable alternative in scenarios where surgery is not feasible or when patients express a preference for less invasive treatments. This result was robust to changes in most model parameters, but somewhat sensitive to the relative likelihood of post-procedure recurrences.