An increasing investment in health technology assessment (HTA) in low-income and middle-income countries has generated greater interest from policy-makers about the value and return on investment (ROI) of HTA. Few studies have, however, quantified the benefits of HTA in terms of its value to the health system. This evaluation aims to quantify the impact and ROI achieved by the HTA agency in India (HTAIn).A framework developed by the University of Glasgow was used to review three 'hta's commissioned by HTAIn between 2018 and 2020, taking into account the opportunity cost of investing in these processes. Costs included fixed costs for HTAIn and costs for undertaking each 'hta'. Attributable benefits are calculated by subtracting the counterfactual (benefits that might have been realised without an HTA) from realised benefits.HTAIn sits under the Department of Health Research, Ministry of Health and Family Welfare, Government of India. It was set up to facilitate the process of transparent and evidence-informed decision-making in healthcare in India.HTA helps decision-makers to understand the consequences of alternative courses of action and to select the options that produce the best outcomes at the lowest cost. Institutionalisation of HTA is seen as pivotal to supporting universal health coverage as a means of supporting a better allocation of finite resources, cost containment and the maximisation of health.Net health benefits are our measure of value. The ROI of HTAIn is calculated by aggregating attributable benefits and offsetting them against the costs of investment.Our findings show that investing in HTAIn yields a return of 9:1, with potential to increase to 71:1 with full implementation of HTA recommendations. Variability of ROI ranged from 5:1 to 40:1 between the different interventions and diseases.While HTAIn requires financial investment, it is an efficient use of resources. The potential for greater impact and the variability of the ROI between interventions underline the importance of planning for implementation and good topic selection in HTA.