Salubrum
Channel case studies

Programmatic display

Supported

The second format.

Thirteen weeks of structured audience testing told us three things to change. The one that mattered most: adding a second ad format, which went on to produce 76% as many clicks as display for 19% of the money.

Client
A cosmetic surgery practice serving a cross-border medical-tourism market
Channel
Programmatic display and native
Period
23 February – 24 August 2026
Media
$13,947 media across two flights
Click-through ratedisplay → the added format
0.093%0.372%4.0×, at an identical CPM
The added formatshare of spend → share of clicks
13.5%34.7%Holds across all four audiences
Retargeting wasteimpressions per person per week
179×1.8×CTR statistically unchanged
Weekly reachdisplay, people per live week
13,73623,474+71% on 29% less weekly spend

Audience test flight → restructured flight

What we were testing

This account did not start as a campaign. It started as a test.

For thirteen weeks from late February we ran five distinct audience definitions, each isolated in its own campaign, plus a separate retargeting campaign. Isolation is the whole point and it is not how most programmatic media is bought — the common approach pools audiences into one campaign and lets the platform optimise between them, which is cheaper to operate and makes it permanently impossible to say which audience did what. Separating them costs efficiency in the short run and buys attribution you can act on.

Everything is recorded at audience × week × channel granularity. That is finer than platform reporting offers by default, and it is the reason the rest of this document can exist.

What the test told us

At the thirteen-week mark we made three changes

  1. 01
    Cut the weakest audienceOne of the five had the lowest click-through rate and the highest cost per click of the set across the full thirteen weeks. It was retired at the changeover rather than carried forward on the assumption it would come good. Four audiences continued.
  2. 02
    Consolidated the survivors into shared campaignsThe audiences moved from five separate campaigns into shared ones, running as audience segments inside them. At this budget level, splitting a small daily spend across many campaigns starves each one of the volume it needs to deliver efficiently. The test had already given us the per-audience read we ran the structure to get.
  3. 03
    Added a second ad formatNative inventory was introduced alongside display, carrying the same four audience definitions at the same negotiated CPM. This was our recommendation and it is the change with the largest measured effect.

What follows is what each change produced. Every figure is like-for-like: same advertiser, same platform, same audience definitions, same media price.

The control

Why the price is fixed, and why that matters

The media is bought at a fixed CPM. Across all fifteen channel-by-flight cells in this dataset the effective cost per thousand impressions sits between $7.63 and $7.97. Price is a constant.

That removes the usual escape hatch. We cannot attribute any of these results to buying impressions more cheaply, because there was no cheaper price to get. Everything below is a delivery result — a consequence of which people saw the ads, how often, and in what format. It also means one thing we are explicitly not claiming: holding CPM flat is the contract, not an achievement.

Result 1

The second format

Native ran across the same ten weeks, against the same four audience definitions, at the same fixed CPM as display. The only variable is the format. That makes it the closest thing in this account to a controlled experiment, and the result is not marginal.

Click-through rate by audience and format

Same ten weeks, same audience definitions, same price per thousand impressions.

  • Display
  • Native — the added format

Audience A

0.097%
0.394%

Audience B

0.098%
0.380%

Audience C

0.085%
0.382%

Audience D

0.080%
0.324%
  • 0
  • 0.10%
  • 0.20%
  • 0.30%
  • 0.40%
Four audiences, four independent replications. The narrowest gap is 3.9× and the widest 4.5×, so no single segment is carrying the average.
The added format against display — same weeks, same audiences, same price
Second flightDisplayNativeNative vs display
Click-through rate0.0927%0.3719%4.0×
Cost per click$8.58$2.10−75.5%
Engagement rate0.0228%0.0885%3.9×
Media spend$4,223.10$785.6918.6%
Clicks delivered49237476.0%

Read the last two rows together. Native produced 76% as many clicks as display, on 19% of the money. Across the flight, 13.5% of spend generated 34.7% of clicks. At a two-proportion z of 21.9 this is not a small-sample accident, and because it replicates across four independent audiences it is not one lucky segment either.

The practical consequence is a standing reallocation case: every dollar moved from display to native in this account has bought roughly four times the click volume at the same media price.

Result 2

The waste nobody was looking at

The second change surfaced something the test structure had been quietly hiding.

Retargeting pools shrink. The audience is people who already visited the site, and if the budget holds constant while that pool contracts, the platform does the only thing available to it: serve the same people more often. Over thirteen weeks this campaign climbed from roughly 23 impressions per person per week to 179.

Retargeting: impressions per person, per week

The pool contracted. The budget did not.

  • During the audience test
  • After the changes
04590135180changes made179×23×1.5–2.1× for ten straight weeks23 Feb25 May24 Aug
Line breaks are weeks with no delivery — one dark fortnight in each flight. The 20 April week is excluded as noise (six retargeting impressions in total). Worked example for the peak: w/c 18 May, 12,213 impressions ÷ 69 people = 177.0, on $93.65 of media.

Since the changes, the same campaign has run between 1.5 and 2.1 impressions per person per week, every week, for ten weeks — and its click-through rate is statistically unchanged (0.2036% → 0.2088%, z = 0.28).

That combination is the finding. The campaign was never underperforming on any metric a standard report shows. It was performing identically while spending most of its budget on people who had already seen the ad thirty times. No campaign-level dashboard surfaces this, because no campaign-level dashboard divides impressions by unique people. Ours does, weekly, per audience.

Result 3

Reach

The same pattern held, less dramatically, on prospecting display. Comparing display only, so that the added format cannot flatter the comparison, the restructured flight bought 29% less media per week and put it in front of 71% more people.

Per live week, display only, indexed to the test flight = 100

Spend and impressions fell together. Reach moved the other way.

Audience test = 100

  • Media spend
    71−29%
  • Impressions
    71−29%
  • People reached
    171+71%
Normalised per live week so the flights' different lengths (12 vs 10 delivering weeks) cannot drive the result. Absolute weekly figures: spend $593.81 → $422.31; impressions 75,172 → 53,090; people reached 13,736 → 23,474. Display frequency fell from 5.5 to 2.3 impressions per person per week.

One number moved against us, and it belongs here rather than in a footnote. Display click-through rate fell from 0.1168% to 0.0927% — a real decline at z = 4.26 across 1.4 million impressions, holding for each of the four audiences individually. The likely mechanism is the reach expansion itself: repeated exposure to a small, already-warm pool clicks harder than first contact with a cold, broad one, and we roughly halved frequency. We cannot fully separate that from ordinary creative fatigue or inventory drift, so we offer it as the leading explanation rather than a proven one. Our judgement, stated as a judgement, is that for a service with a three-to-six-month consideration cycle we would rather reach 23,000 people twice a week than 13,700 people five and a half times — and note that the format change in Result 1 more than recovered the lost click volume at a quarter of the cost.

Limits of the evidence

What we cannot tell you

This study measures media delivery. It does not measure patients, and we would rather be explicit about the gap than let a reader fill it in.

One conversion has been recorded across the entire engagement — week of 29 June, on display. We cite it for exactly one purpose: it confirms the conversion pixel and the reporting pipeline work end to end. It is not evidence of performance and cannot be turned into any rate. Low recorded conversion volume is expected for a service with a three-to-six-month consideration cycle and a cross-border enquiry path that mostly does not touch the tracked form.

The client reports an increase in site visits and consultation enquiries over this period. They are not tracking attribution, and neither are we. We record the statement because withholding it would be its own distortion — but it is an unverified client observation, we make no claim that this media caused it, and nothing above rests on it.

A fair summary of what was bought: a structured test produced three decisions, and those decisions produced four times the click rate on a new format, the elimination of a large recurring waste, and materially wider reach — all at an unchanged media price. Whether that has produced more patients is a question this data cannot answer, and we would rather say so than imply otherwise.

The ledger

What we retired

Four claims were available in this data and did not survive checking. We list them because a reader deciding whether to trust the numbers above should see what we throw away.

  • Retired
    “Click-through rate up 15%, cost per click down 13%”The blended, all-channel before-and-after — arithmetically correct, significant at z = 3.45, and the figure a standard platform report would surface. It is entirely the effect of adding native. On like-for-like display the direction reverses, as stated in Result 3. Publishing the blended number as a buying improvement would have been the single most misleading thing available here.
  • Retired
    “Click-through rate more than doubled (+107%)”An averaging error — the mean of per-row rates weights a low-volume native row equally with a hundred-thousand-impression display row. Aggregate clicks over aggregate impressions is the honest calculation, and it is what every rate on this page uses.
  • Retired
    “Engagement rate up 54%”Same channel-mix problem. Display-only engagement rate is flat: 0.0223% to 0.0228%.
  • Retired
    Any cost-per-acquisition figureThe account has recorded exactly one conversion. At n = 1 a CPA is purely a choice of denominator — $211.87, $5,814.29 and $13,947.30 are all defensible and all meaningless. No CPA, conversion rate or return figure appears anywhere in this study.
  • Unproven
    That halving frequency caused the display click-rate declineMechanically plausible and consistent with the data, but not isolated from creative fatigue, seasonality or inventory shifts. Stated as a hypothesis, not a finding.
  • Holds
    The format result and the frequency resultNative at 4× display click-through replicates across four independent audiences at z = 21.9, at an identical media price. Frequency is a ratio of two sums taken at one granularity, on 1.4 million impressions. Neither depends on an assumption.

Method. Figures are computed from per-audience, per-week, per-channel delivery records synced from the platform API into a warehouse, covering 23 February to 24 August 2026. Rates are aggregate — total clicks divided by total impressions — never averages of per-row rates. Comparisons between the two flights are normalised per delivering week (12 and 10 respectively). Significance is a two-proportion z-test. Every figure on this page is reproducible from the query set retained with the source file.

Limits. Unique-reach counts are reported by the platform per week and per audience segment. Summed across weeks they measure person-weeks of reach, not distinct individuals, and they are not de-duplicated between audience segments or between channels — so they are never summed across channels here. That segment overlap runs against the result reported above: the test flight ran five display audiences to the later flight's four, so any overlap inflates the test flight and understates the improvement. Frequency, being a ratio taken at one granularity, is unaffected. Both flights contain one fortnight of no delivery and are separated by a three-week gap. Effective CPM is contractually fixed, so no claim of price improvement is made or implied. Both flights were run by us; this is a record of testing and iteration within one engagement, not a comparison against another agency's work. One client, one platform, two flights — a single case, not a generalisable result.

Confidentiality. The advertiser is anonymised at our own initiative, not at their request. Client name, campaign names, audience definitions and platform identifiers are withheld. Figures are unaltered.

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