An example of trial-based EE is presented in the study by Hoeijenbos et al [26]. The authors conducted
a cost-utility analysis to compare the implementation of an evidence-based physiotherapy
guideline for low back pain. Based on a randomized trial of 500 patients with back pain, the authors
concluded that the evidence-based physiotherapy guideline was not cost-effective compared to the
standard guideline dissemination method as no differences were found between both costs and effects
of these strategies. Another example of a trial-based EE is the three-year prospective CUA study
comparing 104 patients randomized to medical management or laparoscopic surgery in patients with
chronic gastroesophageal reflux disease [19]. In this study, the authors reported that surgery was fairly
cost-effective with an ICUR of $29,000 per QALY gained.