2.3 · Our Approach
Approximate Monthly Cost
Running a HIPAA-compliant platform on AWS is not free, but it is far cheaper than the equivalent stack built across multiple vendors with separate compliance contracts. This page lays out the monthly cost we expect at two stages: the early startup phase with a handful of pilot clinics, and a scaled phase with fifty or more active clinics handling real document volume. All numbers are rough estimates in U.S. dollars, intended to make budgeting realistic rather than to predict precise bills.
Startup phase
This is where we sit today and for the next six to twelve months. Light traffic, small database, occasional AI usage, a few clinics on board for testing and early production.
| Service | Monthly range | Notes |
|---|---|---|
| App Runner (managed container) | $15 to $35 | A small always-on container (0.25 to 1 vCPU) plus serving traffic. It does not scale to zero, so there is a modest idle floor in exchange for no cold starts and simpler operations. |
| RDS Postgres (db.t4g.small, single availability zone) | $30 to $50 | Adequate for early traffic and small data volumes. |
| S3 storage | $1 to $5 | Scales linearly with how many gigabytes of documents we hold. |
| Bedrock with Claude | $20 to $100 | The swing factor. Light analysis runs cost little; heavy use scales the bill quickly. |
| Cognito | Free | Free for the first 50,000 monthly active users. |
| CloudWatch Logs | $5 to $15 | Application logs at startup volumes. |
| SES (transactional email) | ~$1 | Password resets, intake confirmations, notifications. |
| CloudFront (content delivery) | $5 to $20 | At light traffic. |
| Secrets Manager | $2 to $5 | Scales with how many secrets we store. |
| Data transfer out | $5 to $20 | Bandwidth out of AWS to clinic browsers. |
| Realistic startup total | $80 to $250 | Biggest variable is Bedrock usage. Everything else is fairly predictable. |
Scale phase
Fifty or more active clinics, regular AI usage on real document volume, hundreds of gigabytes of stored files, and full-time operational traffic.
| Service | Monthly range | Notes |
|---|---|---|
| App Runner (managed container) | $60 to $180 | Auto-scales container instances with traffic. Higher serving load plus more concurrent instances during busy hours. |
| RDS Aurora Serverless v2 Postgres | $150 to $400 | Auto-scaling: cost rises with real traffic instead of provisioning for peak. |
| S3 storage (terabytes of documents) | $50 to $200 | Lifecycle policies can move old files to cheaper tiers automatically. |
| Bedrock with Claude (heavy usage) | $500 to $2,000 | The largest single line item. Roughly proportional to documents analyzed. |
| CloudFront (high traffic) | $50 to $200 | Global content delivery at scale. |
| CloudWatch and monitoring | $30 to $80 | Full observability across services. |
| Everything else combined | $50 to $150 | Cognito, SES, Secrets Manager, data transfer, backups. |
| Realistic scale total | $900 to $3,200 | Bedrock dominates the bill. The rest grows gradually. |
How this compares to the alternatives
For context, the same platform built on Vercel Enterprise plus Neon Business plus Bedrock starts at roughly $1,500 to $3,000 per month before any usage, simply for the right to sign Business Associate Agreements with those vendors. The all-AWS path is meaningfully cheaper at every stage, but the gap is largest at scale.
| Stack | Startup phase | Scale phase |
|---|---|---|
| All-AWS (our path) | $80 to $250 | $900 to $3,200 |
| Vercel Enterprise + Neon Business + Bedrock | $1,500 to $3,000 | $3,000 to $6,500 |
What controls the bill
A few levers swing the cost most. These are the ones to revisit any time the bill jumps.
| Lever | How it moves the bill |
|---|---|
| AI usage volume | Every document run through Bedrock costs money proportional to tokens sent and received. Analyzing every uploaded file is expensive; analyzing only on request is cheap. A product decision more than a technical one. |
| Database size and traffic | Dominated by hours of active serving and total stored data. Aurora Serverless v2 scales down during quiet hours, which helps significantly. |
| File volume | S3 is cheap per gigabyte, but adds up at hundreds of clinics over years. Lifecycle policies move cold files to cheaper tiers. |
| Backup retention | Longer retention means more storage. We default to the HIPAA-required six years and do not extend without a reason. |
Billing safeguards
AWS will let a bill grow indefinitely without warning unless you configure alerts. We set the following on day one. These are required steps on the AWS Setup Checklist page.
| Safeguard | How it works |
|---|---|
| Billing alerts | Email and phone alerts trigger at $50, $100, $250, and $500 per month so a runaway bill cannot grow silently. |
| Anomaly detection | AWS Cost Anomaly Detection flags unusual spikes, such as a runaway loop hitting Bedrock. |
| Per-service spending caps | Configured wherever AWS exposes them, so a single service cannot blow past its budget. |