Case Study
How a Systematic Quality Score Strategy Lifted CTR by 47% and Quality Score by 25%
In a market where every extra cent on cost-per-click erodes margin, Quality Score remains one of the most underused levers in Google Ads. Estenove, a health tourism provider specializing in hair transplants, runs a mid six-figure monthly budget in one of the industry's most contested categories. Rather than treating Quality Score as a metric to check occasionally, the team turned it into an ongoing, AI-assisted ad copy program, run continuously from November 2025 through the end of July 2026. Nine months in, click-through rate was up 47%, and the account's cost-weighted Quality Score had risen by 25%.
Murat Alsac
Founder & Partner
"The scale we achieved through their automated ad creative testing allowed us to find winning variants 10x faster than before."
In a market where every extra cent on cost-per-click erodes margin, Quality Score remains one of the most underused levers in Google Ads. Estenove, a health tourism provider specializing in hair transplants, runs a mid six-figure monthly budget in one of the industry's most contested categories. Rather than treating Quality Score as a metric to check occasionally, the team turned it into an ongoing, AI-assisted ad copy program, run continuously from November 2025 through the end of July 2026. Nine months in, click-through rate was up 47%, and the account's cost-weighted Quality Score had risen by 25%.
At a glance
Budget: Mid six-figure monthly spend
Duration: 9 months (Nov 2025 - Jul 2026)
Cadence: Ad copy revised every 2 weeks
Result: +47% CTR, +25% Quality Score
The challenge: A crowded field, dozens of competitors
Before the project began in November 2025, Estenove's account was underperforming on both ad relevance and click-through rate for a category this competitive. Hair transplant and health tourism is a crowded, high-intent, high-CPC vertical. Dozens of clinics compete for the same searchers, so ad relevance and copy quality directly affect how efficiently the budget competes.
The approach: An AI-assisted, data-driven ad copy cycle
At this spend level, ad copy can't be revised by feel or on an ad-hoc basis. The team needed a system that was both fast and consistent, so they built one. Account and keyword-level performance data moved from the Google Ads API into Google Sheets via the Sheets API, giving a structured, continuously updated view of relevance and Quality Score signals. On top of this, the team built an internal Ad Text Playbook: a framework for what strong, relevant ad copy looks like in the hair transplant and health tourism vertical. Using Claude, connected to the team's Drive via Cursor, the playbook guided a revision of responsive search ad copy every two weeks. What is usually a manual, occasional process became a consistent cycle, sustained for nine months on a budget where that consistency mattered.
The results: A steady, compounding lift over nine months
The impact built up gradually and held. From November 2025 through the end of July 2026, Estenove's cost-weighted Quality Score rose by 25%, and click-through rate rose by 47%. Both came from the bi-weekly, playbook-driven ad copy cycle compounding over time, not from a single one-off change.
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