The verdict in three sentences
In 2026, healthcare SaaS (40-150 EUR/user/month) wins for standard needs, quick to cover and not very specific. Custom (30,000-90,000 EUR) prevails when your protocols, interoperability and business rules fall outside a vendor's scope, or when the number of users makes SaaS more expensive over time. The right decision is made on the 5-year total cost of ownership (TCO), not on the entry price.
When SaaS is enough, when custom is required
The first trade-off is functional before it is financial. This table summarizes the typical cases.
| Situation | SaaS | Custom |
|---|---|---|
| Standard needs, not very specific | Recommended | Oversized |
| Particular business protocols | Limited | Recommended |
| Strong interoperability (ERP, lab) | Often partial | Native |
| Specific HDS hosting | Depends on vendor | Controlled |
| < 5 users | Cost-effective | Too expensive |
| > 20 users | Rising cost | Cost-effective |
| Code ownership and evolution | No | Yes |
In other words: the more standard your needs and the smaller your team, the more SaaS wins; the more users, specifics and integrations you have, the more custom becomes relevant.
5-year TCO: the real comparison
The entry price lies. Here is an estimate of the 5-year total cost of ownership by number of users, HDS hosting included.
| Number of users | SaaS 5 years (est.) | Custom 5 years (est.) | Tipping point |
|---|---|---|---|
| 5 users | 12,000 - 45,000 EUR | 45,000 - 105,000 EUR | SaaS |
| 10 users | 24,000 - 90,000 EUR | 50,000 - 115,000 EUR | SaaS / balanced |
| 20 users | 48,000 - 180,000 EUR | 60,000 - 130,000 EUR | Custom |
| 40 users | 96,000 - 360,000 EUR | 75,000 - 160,000 EUR | Custom |
| 80 users | 192,000 - 720,000 EUR | 100,000 - 200,000 EUR | Custom |
Custom includes the initial investment (30,000-90,000 EUR) plus annual maintenance (~18 %) and HDS hosting (~700-1,200 EUR/month). Beyond 15-20 users, it generally becomes cheaper than SaaS over 5 years.
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Mini case study
Sophie, director of a 3-center care network in Belgium, equips 28 users. A SaaS at 90 EUR/user/month comes to 28 x 90 x 12 = 30,240 EUR/year, i.e. 151,200 EUR over 5 years, with no control over the code or interoperability.
She commissions a custom solution at 70,000 EUR, with maintenance at 12,600 EUR/year and HDS hosting at 900 EUR/month (10,800 EUR/year). The 5-year TCO comes to 70,000 + 5 x (12,600 + 10,800) = 187,000 EUR... but with no license hikes and an owned asset. Factoring in interoperability gains (lab, accounting) valued at 20,000 EUR/year, custom becomes clearly more advantageous from year 3.
FAQ
Is SaaS always cheaper? No. At entry yes, but the cost grows with the number of users. Beyond 15-20 users, custom is often cheaper over 5 years.
Does custom handle interoperability? Yes, it is one of its strengths: native API connections with labs, ERP, accounting or an existing patient record, where SaaS often stays closed.
How do I factor HDS hosting into the decision? It adds to the TCO of both options (~700-1,200 EUR/month). With custom you choose the certified host; with SaaS you depend on the vendor's.
How long for custom healthcare software? Budget 4 to 8 months depending on scope, versus a few weeks for SaaS. Custom takes more time but delivers exactly your protocols.
Can I start on SaaS then move to custom? Yes, it is a common strategy: validate needs on SaaS, then switch to custom when volume and specifics justify it economically.
Let's scope your project. Tell us your number of users, interoperability needs and whether HDS hosting is required, for a quantified 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.
