Runway
Runway needed a way to grow revenue without sacrificing efficiency.
Runway needed a way to grow revenue without sacrificing efficiency.
Runway needed a way to grow revenue without sacrificing efficiency.
Challenge
Runway Health is a U.S.-based travel telemedicine startup offering online prescriptions for essential travel medications, including malaria, typhoid, and altitude sickness. As demand grew, the team looked to paid media as the primary lever to scale revenue. However, each attempt to increase ad spend failed to deliver proportional revenue growth. Efficiency declined, acquisition costs climbed, and profitability came under pressure, making scale feel risky rather than repeatable. Runway Health needed a way to grow revenue while maintaining strong efficiency and confidence in their marketing engine.
Runway Health is a U.S.-based travel telemedicine startup offering online prescriptions for essential travel medications, including malaria, typhoid, and altitude sickness. As demand grew, the team looked to paid media as the primary lever to scale revenue. However, each attempt to increase ad spend failed to deliver proportional revenue growth. Efficiency declined, acquisition costs climbed, and profitability came under pressure, making scale feel risky rather than repeatable. Runway Health needed a way to grow revenue while maintaining strong efficiency and confidence in their marketing engine.
Runway Health is a U.S.-based travel telemedicine startup offering online prescriptions for essential travel medications, including malaria, typhoid, and altitude sickness. As demand grew, the team looked to paid media as the primary lever to scale revenue. However, each attempt to increase ad spend failed to deliver proportional revenue growth. Efficiency declined, acquisition costs climbed, and profitability came under pressure, making scale feel risky rather than repeatable. Runway Health needed a way to grow revenue while maintaining strong efficiency and confidence in their marketing engine.
Solution
In April 2025, a strategic audit revealed that growth was being held back by structural inefficiencies, weak audience signals, and gaps in high-intent keyword coverage. While spend could increase, the account lacked the foundations needed to scale efficiently. Over the following months, several recommendations were implemented internally. These changes improved efficiency and reduced wasted spend, but they did not unlock meaningful revenue growth. The program was still constrained by its underlying structure and targeting limitations. In June 2025, account management was fully taken over and the program was rebuilt with scale in mind. Ad copy and audience signals were strengthened across PMax campaigns, keyword coverage was expanded to capture high-intent travel health demand, and non-converting traffic was systematically excluded. Bidding strategies and budget allocation were reworked to prioritize revenue, with increased focus on higher-margin segments to ensure growth remained profitable.
In April 2025, a strategic audit revealed that growth was being held back by structural inefficiencies, weak audience signals, and gaps in high-intent keyword coverage. While spend could increase, the account lacked the foundations needed to scale efficiently. Over the following months, several recommendations were implemented internally. These changes improved efficiency and reduced wasted spend, but they did not unlock meaningful revenue growth. The program was still constrained by its underlying structure and targeting limitations. In June 2025, account management was fully taken over and the program was rebuilt with scale in mind. Ad copy and audience signals were strengthened across PMax campaigns, keyword coverage was expanded to capture high-intent travel health demand, and non-converting traffic was systematically excluded. Bidding strategies and budget allocation were reworked to prioritize revenue, with increased focus on higher-margin segments to ensure growth remained profitable.
In April 2025, a strategic audit revealed that growth was being held back by structural inefficiencies, weak audience signals, and gaps in high-intent keyword coverage. While spend could increase, the account lacked the foundations needed to scale efficiently. Over the following months, several recommendations were implemented internally. These changes improved efficiency and reduced wasted spend, but they did not unlock meaningful revenue growth. The program was still constrained by its underlying structure and targeting limitations. In June 2025, account management was fully taken over and the program was rebuilt with scale in mind. Ad copy and audience signals were strengthened across PMax campaigns, keyword coverage was expanded to capture high-intent travel health demand, and non-converting traffic was systematically excluded. Bidding strategies and budget allocation were reworked to prioritize revenue, with increased focus on higher-margin segments to ensure growth remained profitable.
Results
Before the rebuild (Jan–Apr 2025 vs. Jan–Apr 2024)
Revenue increased by 20% and conversions by 16%, with ROAS up 21% and CPA down 14%. While efficiency improved, top-line growth remained limited and scaling continued to be constrained.
After the rebuild (Jun–Sep 2025 vs. Jun–Sep 2024)
Revenue more than doubled, up 103%, with conversions also increasing 103%. ROAS surged 166% while CPA dropped 62%, delivering the strongest performance in Runway Health’s history.
The program rebuild marked a clear turning point. Prior to June 2025, Runway Health could not scale without sacrificing efficiency. After the new structure went live, the business achieved both simultaneously, sustaining high ROAS while unlocking significant year-over-year revenue growth and profitability.
The chart below highlights this turning point — showing how performance accelerated dramatically after the new structure went live.
"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."
"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."
"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."
Joshua Rome
CEO | Runway Health
Read More Case Studies
Read More Case Studies
Read More Case Studies
WeChalet’s campaigns were under pressure, with declining traffic, rising costs, and limited booking growth.
WeChalet’s campaigns were under pressure, with declining traffic, rising costs, and limited booking growth.
WeChalet’s campaigns were under pressure, with declining traffic, rising costs, and limited booking growth.
UniversityHaus needed to efficiently increase qualified leads within a fixed budget.
UniversityHaus needed to efficiently increase qualified leads within a fixed budget.
UniversityHaus needed to efficiently increase qualified leads within a fixed budget.
The company needed to restore growth through international expansion and localization.
The company needed to restore growth through international expansion and localization.
The company needed to restore growth through international expansion and localization.
Ready to Scale Profitably?
Ready to Scale Profitably?
Ready to Scale Profitably?
Let's discuss how Digital Sardine can help you build scalable, high-performance campaigns without the agency bloat.
Let's discuss how Digital Sardine can help you build scalable, high-performance campaigns without the agency bloat.
Let's discuss how Digital Sardine can help you build scalable, high-performance campaigns without the agency bloat.
Or email us directly at flavio@digitalsardine.com
Or email us directly at flavio@digitalsardine.com
Or email us directly at flavio@digitalsardine.com
Digital Sardine™
Boutique performance marketing consultancy for high-growth
brands in travel, healthcare, and B2C lead-gen.
Digital Sardine™
Boutique performance marketing consultancy for high-growth
brands in travel, healthcare, and B2C lead-gen.
Digital Sardine™
Boutique performance marketing consultancy for high-growth brands in travel, healthcare, and B2C lead-gen.
© 2025 Digital Sardine. All rights reserved.
© 2025 Digital Sardine. All rights reserved.
© 2025 Digital Sardine. All rights reserved.