Abstract Indoor air pollution from burning solid fuels for cooking is a major environmental health problem in developing countries, predominantly affecting children and women. Traditional household energy practices also contribute to substantial time loss and drudgery among households. While effective interventions exist, levels of investment to date have been very low, in part due to lack of evidence on economic viability. Between 2004 and 2007, different combinations of interventions – improved stoves, smoke hoods and a switch to liquefied petroleum gas – were implemented in poor communities in Nepal, Sudan and Kenya. The impacts were extensively evaluated and provided the basis for a household-level cost-benefit analysis, which essentially followed the methodology proposed by the World Health Organization. The results suggest that interventions are justified on economic grounds with estimated internal rates of return of 19%, 429% and 62% in Nepal, Kenya and Sudan, respectively. Time savings constituted by far the most important benefit followed by fuel cost savings; direct health improvements were a small component of the overall benefit. This paper describes the methodology applied, discusses the findings and highlights the methodological challenges that arise when a global approach is applied to a local programme.