The debate concerning the adoption of a pragmatic or explanatory attitude to clinical trials as well as the exact points of distinction between the two attitudes, has lasted for more than 40 years. Recently, new methodological proposals have been given as a pragmatic-explanatory continuum indicator summary tool and mechanistic-practical framework to distinguish the two attitudes. In this review, we provide a guide to the literature concerning the debate regarding the choice between explanatory and pragmatic attitudes in trial-based economic evaluations, focusing on the therapies for burns.