Most cloud VMs have network-attached storage working through a billing layer, and its IOPS numbers are pathetic. This makes running your own DB in a cloud VM much less reasonable. Now you can use local NVMe, but you still have to set up your own failover.

The original promise of the cloud is "you pay us less than you pay your sysadmins", which is not entirely unreasonable, especially at early stages.

Of course running on bare metal from Europe's own Hetzner is even more cost-efficient, if you already have a lot of sysadmin chops.