... there are only three ways to do it and they all cost money. One way is to use an output transformer, another way is the way we do it, which we patented. Most high end companies don’t like paying patent fees solely on ego (’not invented here’). There’s an integrated circuit that does the job as well, but many tube preamp producers are loathe to put something like that at the output of their preamp.
And then there's the fourth way, which I think may be the most common: use an operational amplifier. ("Op-amp.") They can be fully discrete, and seem to be the approach used by many, such as ARC, for example.