Background and Objectives: The Pacific Island Countries face some of the highest rates of Noncommunicable Diseases (NCDs). This study estimates the economic costs of NCDs for each year from 2015 to 2040, focusing on eleven Pacific Island nations. Data and Methods: Two methods were used to estimate the mortality and morbidity costs using a â€˜value of lost outputâ€™ and â€˜cost of illnessâ€™ approach respectively. Results: Five results stand out in terms of projected economic costs of NCD mortality and morbidity analyses in the Pacific: (i) The economic burden of NCDs in the Pacific is greater than expected for middle-income countries; (ii) Although cardiovascular disease is the biggest contributor to the mortality burden in the region, diabetes plays a far greater role in the Pacific countries compared to the global average; (iii) The economic burden of NCDs is increasing with time, especially as incomes rise; (iv)The biggest driver of lost output is the potential loss of labor due to early death from NCDs; and (v) The cost of illness due to diabetes is high across the Pacific countries, with highest among the Polynesian countries. Conclusions: NCDs alone can put enormous threat to the small Pacific economies. Targeted interventions to reduce disease prevalence, as outlined in the Pacific NCDs Roadmap, are vital to reduce the long-term costs associated with NCD mortality and morbidity.