This within-trial economic evaluation shows that a multicomponent QI intervention that combines patient and physician support strategies may be cost-effective (improved intermediate clinical outcomes at higher costs) compared to usual care for multiple risk factor control and cardiovascular risk reductions from healthcare system and societal perspectives in South Asia depending on the range of willingness to pay values. The ICERs for a 1-point % reduction in HbA1c was <0.5x GDP per capita for India, and for the outcomes: 5-unit reduction in SBP (mmHg) and 10-unit reduction in LDLc (mg/dl), fall under 0.25x GDP per capita. Further, the ICER per 1-point % increase in the achievement of multiple risk factor control was <2xGDP per capita.