The verdict in three sentences
A vertical healthcare solution costs 15 to 45 EUR/practitioner/month plus configuration, while custom development starts at 30,000 EUR excl. VAT excluding HDS hosting. Below 15 practitioners, the vertical almost always wins on TCO; above that, or with specific interoperability needs, custom takes the lead. The real trade-off is vendor dependence and control of your health data.
Vertical vs custom: the TCO comparison
Comparison over 5 years by facility size (2026 estimate, HDS hosting included on the custom side).
| Criterion | Vertical solution | Custom |
|---|---|---|
| Entry cost | 2,000 - 8,000 EUR (config) | 30,000 - 55,000 EUR excl. VAT |
| Recurring cost | 15 - 45 EUR/practitioner/month | 5,000 - 10,000 EUR/yr |
| HDS hosting | included | 2,000 - 5,000 EUR/yr |
| Customization | limited | total |
| HL7/FHIR interoperability | vendor-dependent | native |
| Vendor dependence | high | low |
For 8 practitioners over 5 years, the vertical at 30 EUR/month is ~2,000 EUR config + 14,400 EUR = ~16,400 EUR. Custom at 35,000 EUR + 35,000 EUR recurring = ~70,000 EUR. For 30 practitioners, the vertical climbs to ~56,000 EUR and the gap narrows sharply.
Costed decision grid
Use these thresholds to decide quickly (2026 order of magnitude).
| Situation | Recommendation |
|---|---|
| Under 15 practitioners, standard needs | Vertical |
| Over 25 practitioners, multi-site | Custom or hybrid |
| Critical HL7/FHIR interoperability | Custom |
| Entry budget < 10,000 EUR | Vertical |
| Highly specific business processes | Custom |
| Data sovereignty required | Custom (controlled HDS) |
The hybrid option (vertical + custom bricks connected via HL7/FHIR) is often the best compromise above 20 practitioners.
Mini case study
Claire, director of a 22-practitioner multidisciplinary health center in Lyon, was hesitating. The vertical over 5 years cost ~41,000 EUR but blocked integration with her partner lab (no FHIR). A custom core at 40,000 EUR excl. VAT plus 4,000 EUR/year of HDS comes to ~60,000 EUR over 5 years, but automates lab exchanges and saves 1.5 FTE of data entry, about ~55,000 EUR/year. The 19,000 EUR gap over 5 years is absorbed within the first operating year.
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FAQ
At what practitioner count does custom become relevant?
Generally above 20 to 25 practitioners, or sooner if interoperability and customization are critical. Below 15, the vertical stays more economical.
What does HL7/FHIR interoperability change concretely?
It lets you exchange records, results and prescriptions with labs, hospitals and other software without re-keying. It is a decisive criterion once you work in a care network.
Is HDS hosting mandatory in both cases?
Yes, as soon as personal health data is processed. In a vertical it is usually included; in custom, budget 2,000 to 5,000 EUR/year.
Can vendor lock-in be avoided?
Custom guarantees ownership of code and data. A well-chosen vertical limits risk via standard exports, but control stays partial.
What timeline for a custom project?
Budget 16 to 22 weeks for an HDS-compliant core, versus a few weeks of configuration for a vertical.
Let's scope your project. Tell us your practitioner count, interoperability requirements (HL7/FHIR) and indicative budget to decide between vertical, custom or hybrid. 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.
