OBJECTIVES: Firstly, to identify what proportion of medical technologies notified to the National Institute for Health and Care Excellence’s (NICE) Medical Technologies Appraisal Committee (MTAC) are selected for evaluation by the MTEP. Secondly, to analyse the MTEP Committee’s interpretation of claimed healthcare system benefits and identify the influence of these benefits on decision-making. METHODS: The NICE website was used to identify: technologies considered by the MTAC up to May 2015; the routing information for each technology; the healthcare system benefit claims and decision data for all technologies routed to the MTEP. The healthcare system benefit claims were categorised according to criteria listed in the NICE MTEP methods guide to facilitate identification of any association between the type of benefit claimed and the decision outcome. The decision-making committee’s conclusions on the claimed healthcare system benefits were interpreted. RESULTS: By May 2015, the MTAC at NICE had considered 157 products, of which 99 were not selected for evaluation. Of the 58 products selected for evaluation, 35 were routed to the MTEP. Seventy-one per cent of MTEP decisions endorsed technology adoption. There have been instances of claimed health system benefits being accepted by the Committee for technologies that ultimately did not receive positive endorsement due to clinical benefit or cost considerations.  CONCLUSIONS: The MTEP is the most commonly used process to assess routed technologies and the majority of MTEP evaluations have resulted in positive endorsement. The MTEP process assigns equal prominence to healthcare system and patient benefits, with decisions being based on the full body evidence available for a technology. However, where evidence of clinical effectiveness was associated with uncertainty, the influence of demonstrated healthcare system benefits appeared to have limited effect on final decision-making.