Land degradation is a serious impediment to improving rural livelihoods in eastern Africa. This paper identifies land degradation patterns based on Land Use Cover Change and Normalized Difference Vegetation Index decline, compares the costs of action against inaction against land degradation using the Total Economic Value approach in four countries – Ethiopia, Kenya, Malawi and Tanzania. Results show that land degradation hotspots cover about 51%, 41%, 23% and 22% of the terrestrial areas in Tanzania, Malawi, Ethiopia and Kenya respectively. The cost of land degradation between 2001-2009 periods is about US$2 billion in Malawi, US$11 billion in Kenya, US$18 billion in Tanzania and US$35 billion in Malawi. These represent about 5%, 7%, 14% and 23%, of GDP in Kenya, Malawi, Tanzania and Ethiopia respectively. The costs of action as compared to the costs of inaction represented only about 23.7%, 24.1%, 26.0% and 26.2% in Ethiopia, Kenya, Malawi and Tanzania.