Assessment of tuberculosis burden in China using a dynamic disease simulation model.

Correspondence to: M Mehra, Janssen Global Services, 700 GMACSO Bldg, Route 202 South, Raritan, NJ 08869, USA. Tel: (+1) 908 927 2667. Fax: (+1) 908 253 3784. e-mail: mmehra@its.jnj.com Article submitted 17 December 2012. Final version accepted 28 March 2013. S E T T I N G : Although a preventable and treatable disease, tuberculosis (TB) is among the top 10 causes of death worldwide. A consequence of inadequately treated drug-susceptible TB (DS-TB) is multidrug-resistant TB (MDR-TB). O B J E C T I V E S : To improve our understanding of the primary drivers of incidence and prevalence of DSand MDR-TB in China. M E T H O D S : The Tuberculosis Disease Transmission Model (TBDTM) uses historical and current disease epidemiology and transmission trends and treatment effectiveness, and accounts for annual changes to these to estimate future DS-TB and MDR-TB burden. R E S U LT S : The model shows that in China, by 2050, incidence, prevalence and mortality of DS-TB will decrease by 32%, 50% and 41%, respectively, whereas MDR-TB will increase by respectively 60%, 48% and 35%. Reduction in DS-TB is a result of high treatment and cure rates leading to a decrease in the prevalence of latent tuberculous infection (LTBI), while the increase in MDR-TB is attributed to inappropriate treatment, leading to high transmission of infection and increased LTBI prevalence. C O N C L U S I O N S : These results demonstrate a reduction in DS-TB in China over the next 40 years, while MDRTB will increase. Improvements in the diagnosis and treatment of MDR-TB are needed to counter this threat. The TBDTM tool has potential value in public health practice by demonstrating the impact of interventions and estimating their cost-effectiveness. K E Y W O R D S : TB; MDR-TB; disease transmission model