The verdict in three sentences
For a single site, an off-the-shelf suite is often the most rational choice. From 3 sites with consolidated reporting, a multi-site custom build catches and beats health SaaS over 5 years. The break-even points are group steering, national-record interoperability and lab/imaging integrations.
5-year TCO for 3 sites
| Scenario | 2026 detail | 5-year TCO |
|---|---|---|
| Health SaaS (low) | 1,200 EUR/site/mo × 3 | 216,000 EUR |
| Health SaaS (high) | 2,500 EUR/site/mo × 3 | 450,000 EUR |
| Custom | 180,000 EUR + 27,000 EUR/yr maint. | 315,000 EUR |
At 1,200 EUR/site, SaaS stays cheaper; at 2,500 EUR/site (advanced modules, HA, support), custom becomes 135,000 EUR cheaper over 5 years, and the gap widens from year 6 as the build is amortised.
Where the decision really plays out
| Break-even point | Off-the-shelf | Multi-site custom |
|---|---|---|
| Consolidated group reporting | Often optional/limited | Native, real time |
| Multi-site (shared patients) | Siloed per site | Unified view |
| National-record/FHIR interoperability | Vendor-dependent | Controlled |
| Lab/imaging integrations | Closed catalogue | Tailored |
| Data reversibility | Limited | Total (code owned) |
| Certified health hosting | Imposed | Your choice, certified |
Recurring costs compared
| Item | Health SaaS | Custom |
|---|---|---|
| Subscription/licence | 43,200-90,000 EUR/yr (3 sites) | 0 EUR |
| Maintenance | included | 27,000 EUR/yr |
| Certified hosting | included | 18,000-30,000 EUR/yr |
| Major evolutions | vendor roadmap | budgeted on demand |
| Cost per extra site | +14,400-30,000 EUR/yr | ~marginal (dev) |
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Mini case study
Ms Fontaine, director of a 3-clinic group in Lille, pays 1,900 EUR/site/month for an off-the-shelf suite, i.e. 68,400 EUR/year, with no reliable consolidated reporting or cross-site patient view. Over 5 years that is 342,000 EUR. Moving to custom at 180,000 EUR + 27,000 EUR/year maintenance (+ 24,000 EUR/year hosting), her 5-year TCO is ~435,000 EUR the first time, but the moment she opens a 4th site the marginal cost is near zero on custom versus +22,800 EUR/year on SaaS. Consolidated steering also gains ~1.5 points of group utilisation, worth several hundred thousand euros of revenue over time.
FAQ
From how many sites does custom become worthwhile? From 3 sites with consolidated reporting, especially if SaaS exceeds 1,800-2,000 EUR/site/month. The marginal cost of an extra site is near zero on custom.
How much does an off-the-shelf health suite cost in 2026? From 1,200 to 2,500 EUR/site/month depending on modules and support, i.e. 216,000-450,000 EUR over 5 years for 3 sites.
Does custom handle national-record interoperability? Yes, it's natively integrated and controlled, unlike suites where it depends on the vendor roadmap and connector catalogue.
What about reversibility and certified hosting? With custom you own the code and database and pick a certified host. With SaaS, reversibility is often limited and hosting imposed.
What maintenance budget for multi-site custom? Budget ~27,000 EUR/year maintenance (15% of the build) plus 18,000-30,000 EUR/year certified hosting for 3 sites.
Let's scope your project. Tell us your number of sites, consolidation needs and integrations (national record, labs): we'll model the SaaS vs custom 5-year TCO. Detailed quote within 48 h. WhatsApp +221 77 596 93 33.
Mohamed Bah
Fondateur, Kolonell
Passionate about digital and entrepreneurship in Africa, Mohamed has been helping Sénégalese businesses with their digital transformation since 2020. Founder of Kolonell, he believes every SME deserves a professional and accessible online présence.
