CHAPTER 5 A population-based macro-simulation model for policy evaluation in diabetes prevention and treatment : the MICADO model

Objectives: Simulation models can assist in diabetes policy by giving projections of future health care use and costs, evaluating policy scenarios for prevention and treatment and extrapolating trial results over time. Most existing models concentrate on known diabetes patients. The MICADO model aims to estimate long-term effects of preventive interventions in persons with and without diabetes. Methods: MICADO includes micro-and macrovascular diseases in relation to their risk factors. Strengths of the model are its population scope and the possibility to assess parameter uncertainty by ways of probabilistic sensitivity analyses. Outcomes are incidence and prevalence of complications, quality of life, costs and cost-effectiveness. We externally validated MICADO's estimates of micro-and macrovascular complications, comparing these to empirical data. Results: MICADO's estimate was 592 (95% Inter-quantile Range (IR): 291 to 842) for the annual number of amputees, which compared well to the registered number of diabetes related amputees in the Netherlands (728). MICADO's incidence of end-stage renal disease (ESRD) was 247 (95% IR: 120 to 363), similar to the registered incidence of ESRD in the Netherlands (277). MICADO performed well in the validation of macrovascular outcomes of population-based cohorts, while it had more difficulty to reflect a highly selected trial population. Conclusions: Validation by comparison with independent empirical data showed that the MICADO model simulates the natural course of diabetes and its micro-and macrovascular complications well. As a population bases model, it can be applied for projections as well as scenario analyses and to evaluate the long-term (cost-) effectiveness of diabetes-related and cardio-vascular interventions.