How Runway Scaled Paid Search—2× Revenue, 50% Lower Acquisition Cost
“Before working with Digital Sardine, every time we increased ad spend, revenue lagged behind and efficiency declined. With the new structure in place, we’re now growing at our strongest pace yet — a major step forward for the business and proof that our marketing efforts are finally scalable.”
— Josh Rome, CEO of Runway Health
Challenge:
Runway Health, a U.S.-based telemedicine startup, provides online prescriptions for key travel medications such as malaria, typhoid, and altitude sickness.
They faced a critical challenge:
Every time they tried to increase ad spend, revenue volume failed to keep up.
Efficiency declined drastically, driving up acquisition costs.
This directly hurt the business bottom line, making it impossible to scale with confidence.
Runway Health needed a way to grow revenue while maintaining strong efficiency.
Approach:
Audit (April 2025): Delivered a strategic audit highlighting inefficiencies, weak audience signals, and missed keyword opportunities.
Internal Optimizations (Apr–May 2025): Runway implemented several recommendations, which improved efficiency but still didn’t unlock growth.
Program Rebuild (June 2025): Took over account management and:
Improved ad copy builds and strengthened audience signals in PMax campaigns.
Expanded keyword coverage across all high-intent travel health conditions.
Implemented exclusions of non-converting traffic.
Changed bidding strategies and optimized budget allocation to maximize revenue.
Became more aggressive on higher-margin segments, ensuring profitable scaling.
Results:
Jan–Apr 2025 vs. Jan–Apr 2024
Revenue +20% | Conversions +16% | ROAS +21% | CPA –14%
Early improvements in efficiency, but limited top-line growth.
Jun–Sep 2025 vs. Jun–Sep 2024
Revenue +103% | Conversions +103% | ROAS +166% | CPA –62%
Following the rebuild, Runway achieved its strongest performance to date — more than doubling revenue while cutting acquisition costs by over half, marking a major leap in both scale and profitability.
📊 The chart below highlights this turning point — showing how performance accelerated dramatically after the new structure went live.
Indexed Performance Trends (2024–2025)
(Jan 2024 = 100)
Teal line: Revenue Index
Purple line: ROAS Index
Vertical markers: Audit (Apr 2025), Internal Optimizations (May 2025), Program Rebuild (Jun 2025)
Takeaway
Runway Health had been unable to scale without hurting efficiency. After the program rebuild in June 2025, they achieved both — sustained high ROAS and more than doubled revenue YoY.
