Health and Economic Impacts of Introducing Vaccae and Enhanced Drug-Resistant Tuberculosis Management Strategies in China

Background China faces high burden of multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). We aimed to evaluate the impacts of Vaccae vaccination and enhanced drug-resistant TB (DR-TB) management strategies.Methods Using a compartmental model calibrated with national TB data, we evaluated 9 interventions: enhanced DR-TB management (S1); Vaccae vaccination for those with latent TB infection, targeting specific age groups (S2: adolescents, S3: adolescents and young adults, S4: working-age adults, S5: elderly); and combined strategies S6-S9. Vaccae's efficacy was 0.547 for the first 5 years, then waning annually. Costs were US$28/dose for Vaccae, US$87/test for Xpert MTB/RIF, and US$13 818/course for BPaLM.Results Strategy S1 is projected to reduce MDR/RR-TB incidence and mortality by 21% (95% UI, 8%-46%) and 54% (38%-67%), respectively, by 2050. Strategy S9 (S5+S1) is more effective, reducing the incidence by 44% (35%-61%) and mortality by 68% (52%-78%), with an ICER of US$7222 (4460-10 779) per DALY averted compared with S1. Additionally, S9 could prevent 24.2 (13.5-32.9) million patient-months of second-line treatment from 2025 to 2050.Conclusions Prioritizing Vaccae vaccination for the elderly and enhancing DR-TB management offer a promising and cost-effective opportunity for China. The findings may have policy implications for other low- and middle-income countries with high MDR/RR-TB burden. Vaccae vaccination for the elderly combined with enhanced drug-resistant TB management could effectively reduce multidrug-resistant or rifampicin-resistant TB incidence and mortality in China at a reasonable cost. This integrated strategy provides important policy insights for tackling drug-resistant TB in high-burden countries.