The verdict in three sentences
In 2026, off-the-shelf software (SaaS) costs 40 to 120 EUR excl. VAT per practitioner per month: fast to deploy but rigid and billed forever. A custom solution (50,000 to 100,000 EUR excl. VAT) becomes profitable once a group exceeds 3 to 4 sites or 25 practitioners, because the cumulative subscription eventually outweighs the upfront investment. In both cases, certified HDS health-data hosting is mandatory and adds 100 to 400 EUR excl. VAT per month.
Off-the-shelf vs custom: the real 2026 comparison
Off-the-shelf software spreads costs across thousands of clients: ideal for a standard single-site clinic. Custom software fits your patient journey, your billing flows and your specific integrations. Here are the 2026 orders of magnitude.
| Criterion | SaaS off-the-shelf | Custom |
|---|---|---|
| Entry cost | 0 to 3,000 EUR (setup) | 50,000 to 100,000 EUR excl. VAT |
| Monthly cost | 40 to 120 EUR/practitioner | 0 (owned) |
| HDS hosting | Included | 100 to 400 EUR/month |
| Customization | Limited | Total |
| Time to launch | 2 to 6 weeks | 4 to 8 months |
| DMP interoperability | Standard | Custom |
| Upgrades | Vendor roadmap | On demand |
SaaS wins on speed and risk; custom wins on control and long-term cost once you reach a certain volume.
The hidden costs: HDS, interoperability, health GDPR
A clinic is not just software: it must meet a strict regulatory framework. These items apply regardless of the model chosen.
| Item | 2026 range (EUR excl. VAT) | Frequency |
|---|---|---|
| Certified HDS hosting | 100 to 400 /month | Monthly |
| DMP / national health record link | 3,000 to 8,000 | One-off |
| Third-party payment interface (Vitale) | 5,000 to 15,000 | One-off |
| Health GDPR audit + DPO | 4,000 to 10,000 | Annual |
| Encrypted redundant backup | 60 to 200 /month | Monthly |
| Corrective maintenance + support | 12 to 20 % of build /year | Annual |
Health GDPR compliance (Article 9, sensitive data) requires encryption, access traceability and a processing register: not an option but a legal prerequisite.
Mini case study
David, director of a group of 4 ophthalmology clinics in Auvergne-Rhône-Alpes, employs 28 practitioners. On SaaS at 85 EUR excl. VAT/practitioner/month, he pays 28 × 85 × 12 = 28,560 EUR excl. VAT per year, or 142,800 EUR over 5 years, HDS already included. A custom core at 80,000 EUR excl. VAT + HDS (250 EUR/month) + support (13,000 EUR/year) comes to 80,000 + (250 × 12 + 13,000) × 5 = 80,000 + 80,000 = 160,000 EUR over 5 years. At 5 years the gap is small, but from year 6 custom pulls ahead (16,000 EUR/year vs 28,560 EUR) and David keeps ownership of the code and his data. His tipping point: above 30 practitioners, custom becomes clearly cheaper.
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FAQ
Is HDS hosting really mandatory?
Yes. As soon as a clinic hosts personal health data through a third party, the host must be HDS-certified. Budget 100 to 400 EUR excl. VAT/month depending on volume and redundancy.
How long to deploy custom software?
Between 4 and 8 months in 2026 depending on scope: patient record + calendar core in 4 months, billing and third-party payment in 6 to 8 months. SaaS deploys in 2 to 6 weeks.
From how many sites is custom profitable?
Generally above 3 to 4 sites or 25 practitioners. Below that, a vendor subscription stays more financially flexible.
Is third-party payment included in the price?
Rarely. The Vitale interface and third-party payment handling are a separate item of 5,000 to 15,000 EUR excl. VAT to add to the budget.
Can we migrate from a vendor to custom without losing history?
Yes, via a controlled import of patient records. Budget 5,000 to 12,000 EUR excl. VAT for data migration plus a safety dual-entry phase.
Let's scope your project. Tell us your number of sites, practitioners and integrations (DMP, third-party payment, HDS): we'll price the most profitable model. 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.