Healthcare 4.0 (H4.0) applications such as telehealth and Internet of Medical things (IoMT) demand ultrahighcapacity, low latency, extensive coverage, energy efficiency, and massive connectivity, stressing the limits of traditional Terrestrial Networks (TNs) infrastructure. The lack of ubiquitous terrestrial coverage and X-haul capacity bottlenecks necessitate integrated Terrestrial and Non-Terrestrial 6G Networks (TNNTNs).However, high deployment cost and energy limitations of NTNs demand efficient solutions to ensure scalable and sustainable healthcare delivery. This paper focuses on minimizing the Total Cost of Ownership (TCO) of the integrated 6G TNNTN formulated as a joint offline cost-aware user association, traffic routing and Virtual Network Function (VNF) placement problem. A cost-efficient low complexity heuristic algorithm(named CHEUR) is developed and evaluated via simulations. The proposed solution is shown to significantly outperform the Stateof-Art (SoA) in terms of energy and cost-efficiency, with CHEUR achieving up to 1.64 times higher energy efficiency and 73.85% TCO reduction. The problem is introduced within a H4.0 scenariowhich includes healthcare focused service function chains (SFCs) aligned with the latest ITU-R framework for IMT-2030.