The verdict in three sentences
For a remote monitoring SaaS for chronic patients, an HDS-certified offer costs 300 to 3,000 EUR excl. VAT a month depending on platform size, a 30 to 80% premium over the same sizing on a standard cloud. That premium buys the host's HDS certification, data located in the European Economic Area, encrypted backups and contractual reversibility, not full compliance of your product. The real first-year budget also includes the mandatory DPIA, a penetration test and a DPO, i.e. 22,000 to 57,000 EUR in total for a startup.
Standard cloud vs HDS: the premium by platform size
The figures below compare the same technical sizing at European hosts, with and without HDS certification (HDS is France's mandatory certification for hosting health data on behalf of third parties). These are 2026 orders of magnitude, excluding application management.
| Platform stage | Typical infrastructure | Standard cloud (excl. VAT/month) | HDS offer (excl. VAT/month) | Premium |
|---|---|---|---|---|
| Seed (1,000 patients) | 2 VMs, 1 managed database, 100 GB | 200 EUR | 330 EUR | +65% |
| Clinical pilot (5,000 patients) | 3 VMs, high-availability database, 250 GB | 450 EUR | 750 EUR | +67% |
| Growth (10,000 patients) | 4 VMs, HA database, 500 GB, staging environment | 900 EUR | 1,400 EUR | +56% |
| Scale (30,000 patients) | Managed Kubernetes, multi-zone, 2 TB | 1,800 EUR | 2,600 EUR | +44% |
| Full HDS managed service (levels 1 to 6) | Same base, operated by the host | 1,700 EUR | 3,000 EUR | +76% |
The relative premium falls with size: the host's fixed compliance costs weigh heavily on a small infrastructure, then get diluted. Hyperscalers also offer HDS-certified regions, often at the same price as their standard services, but with a limited set of eligible services and a sovereignty question your hospital clients will raise.
What you actually pay for with the HDS premium
| Item | Standard cloud | HDS offer | What it changes |
|---|---|---|---|
| Host certification | None or ISO 27001 only | HDS 2.0, physical hosting and managed service activities | Mandatory to host health data for a third party |
| Data location | Free | European Economic Area, transparency on access from abroad | Requirement of the HDS framework published in 2024 |
| Backups | Optional, often same region | Encrypted, off-site, restore tests | +10 to 20% if not included |
| Access traceability | Basic logs | Enhanced, retained logging | Evidence in case of incident or audit |
| Contract | Standard terms | HDS contract with clauses required by the French Public Health Code | Clear roles between host and software vendor |
| Reversibility | Best effort | Contractual reversibility plan | Switch hosts without data loss |
| Support | Tickets in business hours | 24/7 on-call, often optional | 300 to 800 EUR excl. VAT a month |
The host's certification does not cover your application. Access management, application-level encryption, strong authentication for clinicians and business logging remain your responsibility as the software vendor.
The full first-year compliance budget
| Item | 2026 range (excl. VAT) | Frequency |
|---|---|---|
| HDS hosting premium (pilot stage) | 3,600 EUR | Annual |
| Data protection impact assessment (DPIA) with a consultant | 3,000 to 8,000 EUR | Before processing, then updates |
| Security policy and documentation | 2,000 to 6,000 EUR | Initial |
| Application penetration test | 5,000 to 15,000 EUR | Annual |
| Outsourced DPO | 400 to 1,200 EUR a month | Ongoing |
| Strong authentication and application logging (development) | 4,000 to 10,000 EUR | Initial |
| First-year total | 22,400 to 57,000 EUR |
The DPIA is not a formality: large-scale processing of health data for remotely monitored patients falls within the cases where the CNIL considers it mandatory, and it must be completed before go-live.
Mini case study
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Illustrative scenario: Thomas, CTO of a remote monitoring startup for heart failure patients in Nantes, follows 8,000 patients on a standard cloud at 1,100 EUR excl. VAT a month. The equivalent HDS offer costs 1,750 EUR, i.e. +59% and 7,800 EUR more per year. He adds a 5,000 EUR DPIA, an 8,000 EUR penetration test and an outsourced DPO at 600 EUR a month (7,200 EUR): the total first-year premium reaches 28,000 EUR. Per patient, HDS hosting comes to 2.6 EUR per patient per year. On the other side, a single 60,000 EUR-a-year contract with a hospital group is out of reach without HDS hosting: the premium is covered by the first signature.
FAQ
Can a remote monitoring SaaS stay on a standard cloud during testing?
Only with dummy or truly anonymised data. As soon as identifiable health data of a real patient is hosted on behalf of a third party, the host must be HDS-certified, even for a 50-patient pilot.
How long does it take to migrate to an HDS host?
Allow 4 to 8 weeks for a containerised application, DPIA and acceptance testing included. An architecture tightly bound to a hyperscaler's proprietary services may take 2 to 3 months.
Does our startup itself need HDS certification?
No, if you entrust hosting and managed services to a certified provider and do not operate the infrastructure yourself. If your team administers the servers, certification may become necessary, costing 30,000 to 80,000 EUR and 6 to 12 months of preparation.
Are backups included in HDS offers?
Often, but check retention (30 days minimum recommended), location and restore tests. An optional off-site backup usually adds 10 to 20% to the monthly cost.
Does the HDS premium fall with volume?
Yes, it drops from about 65% on a small platform to 40 to 45% above 30,000 patients. Negotiating a 24 or 36 month commitment often brings a 10 to 15% discount.
Let's scope your project. Send us your current architecture, patient volume and commercial deadlines: we will price the HDS migration and the application security work. 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.
