A comparison of the cost-effectiveness of the current standard of care and of the haematology analyser XN31-microscopy combination for diagnosing malaria in a nonendemic countryFIRST REVIEW ROUND - REVIEWERS COMMENTSAUTHORS RESPONSE TO REVIEWERSREVIEWERS COMMENTS.

BACKGROUND: The biological diagnosis of imported malaria cases is a challenge that requires efficient methods, trained staff and high-quality proficiency. Microscopy, rapid diagnosis tests and molecular tests are widely available and provide excellent results. New methods such using haematology analysers have been recently developed. OBJECTIVES: In the context of limited resources, a complete cost-effectiveness analysis of the different scenarios should aid in the decision-making process for the most appropriate methods. METHODS: The full cost-effectiveness of each malaria diagnosis scenario relative to the clinical benefits of the outcome was measured. The study population was a cohort of patients who were receiving health care at Lyon University Hospital for suspected malaria during 2023. Four scenarios were tested: microscopy, rapid diagnosis test + microscopy combination, loop-mediated isothermal amplification (LAMP) + microscopy combination, all identified as the control tests, and haematology analyser XN-31 + microscopy combination, identified as the intervention. The direct costs were calculated based on prices paid in France for material and consumables needed to perform malaria diagnosis for one sample among 1000 tests per year. The indirect cost of technical training, supervision and quality proficiency was calculated based on the hourly salary of the laboratory technician, junior and senior doctors according to the time needed for each scenario. FINDINGS: This approach provides a global approach for determining the cost-effectiveness of the most frequent scenarios for diagnosing malaria. The diagnosis accuracy and the short time-to-result of the haematology analyser combined with microscopy were the key points of the cost-effectiveness result. MAIN CONCLUSION: The generalisability of our findings is restricted by the specificity of the costs observed in France and the limited panel of methods tested. However, this may promote similar studies from other countries to document the cost-effectiveness of the different scenarios used for malaria diagnosis.