# MALDI-TOF MS for malaria vector surveillance: A cost-comparison analysis using a decision-tree approach

## TL;DR

This paper compares MALDI-TOF MS to traditional methods for malaria vector surveillance in Kenya, showing significant time and cost savings.

## Contribution

The study introduces a decision-tree cost-comparison model to evaluate MALDI-TOF MS adoption in low-resource settings for mosquito surveillance.

## Key findings

- Shifting to MALDI-TOF MS could save 74.48% in time and 83% in direct costs for Kenya's malaria vector surveillance.
- The method reduces material and labor costs by up to 84% and 77%, respectively.
- MALDI-TOF MS offers rapid turn-around and lower per-sample costs, suitable for resource-limited settings.

## Abstract

The use of MALDI-TOF MS for mosquito identification and surveillance is routinely used in developed countries as an affordable alternative to molecular methods. However, in low- and middle-income countries (LMIC) where mosquito-borne diseases carry the greatest burden, the method is not commonly employed. Using the Kenyan national malaria program (NMCP) as a case study, we compared the costs of current methods used for malaria vector surveillance to those that would be incurred if MALDI-TOF MS were used instead.

A deterministic decision tree analytic model was developed to systematically calculate the costs associated with materials and labour, and time-to-results for two workflows, i.e., current molecular methods versus MALDI-TOF MS. The analysis assumed an annual sample size of 15,000 mosquitoes (representing the average number of mosquitoes analysed annually by the Kenyan NMCP) processed at a local laboratory in Kenya.

We estimate that if the Kenyan national entomological surveillance program shifted sample processing completely to MALDI-TOF MS, it would result in 74.48% net time saving, up to 84% on material costs and 77% on labour costs, resulting in an overall direct cost savings of 83%.

Adoption of MALDI-TOF MS for malaria vector surveillance can result in substantial time and cost savings. The ease of performance, the rapid turn-around time, and the modest cost per sample may bring a paradigm shift in routine entomological surveillance in Africa.