Tomato is an important crop in Bangladesh and India, contributing to livelihoods and nutrition, but it is heavily affected by pests and diseases. This study analyzes pest and disease damage and farmers’ crop protection methods and quantified the potential economic gains of alternatives to chemical pesticides. Data come from a questionnaire survey of 744 tomato-producing farmers in India (Andhra Pradesh and Karnataka) and Bangladesh (Jashore). Farmers reported an average tomato yield loss from pests and diseases of 11.0 t/ha, of which Phthorimaea absoluta caused 2.1 t/ha. Farmers relied heavily on chemical pesticides, but also applied other methods. Better knowledge of pesticide health risks and beneficial insects and more use of alternative pest control methods were associated with lower pesticide use. Using an economic surplus model, we estimate ex-ante that the promotion of integrated pest management for the control of P. absoluta could generate economic gains of USD 264 million in Bangladesh and India over a 20-year period while insect resistant varieties could generate economic gains of more than USD 8.6 billion over this period.