OBJECTIVES: To forecast and better understand the primary drivers of the incidence and prevalence of and mortality from drug sensitive and multidrug resistant tuberculosis (DS-TB and MDR-TB, respectively).  METHODS: The Tuberculosis Simulation Model (TBSM) is a dynamic disease simulation model that uses historical and current disease incidence, treatment success rates, mortality, and transmission trends and can account for expected market events to estimate future DS-TB and MDR-TB incidence, prevalence and mortality in China.  RESULTS: The model shows that between 2010 and 2050,   DS-TB incidence, prevalence and mortality will decrease by 29%, 52% and 29%, respectively, whereas MDR-TB incidence, prevalence and mortality will fall by 3%, -11% and 10%, respectively.  These reductions would be driven by an expected decrease in the pool of people with latent infection (brought about by improved cure rates which in turn reduces transmission rates) and reduced rate of progression from latent to active TB. CONCLUSIONS: Results from this model demonstrate considerable anticipated decreases in DS-TB and MDR-TB incidence and mortality in China over the next forty years; the decreases are much larger for DS-TB than for MDR-TB.  Improvements in MDR-TB diagnosis and improved cure rates due to better MDR-TB treatments can likewise be expected to decrease MDR-TB incidence, prevalence and mortality over the long run.  This adaptable TBSM tool has potential value in public health practice by forecasting outcomes of interventions and can also be useful for cost effectiveness modeling by country or by region by defining critical unmet need.