Policy evaluation in diabetes prevention and treatment using a population-based macro simulation model: The MICADO model

Aims 

To test a simulation model, the MICADO model, for estimating the long-term effects of interventions in people with and without diabetes.

Methods 

The MICADO model includes micro-and macrovascular diseases in relation to their risk factors. The strengths of this model are its population scope and the possibility to assess parameter uncertainty using probabilistic sensitivity analyses. Outcomes include incidence and prevalence of complications, quality of life, costs and cost-effectiveness. We externally validated MICADO's estimates of micro-and macrovascular complications in a Dutch cohort with diabetes (n = 498 400) by comparing these estimates with national and international empirical data.

Results 

For the annual number of people undergoing amputations, MICADO's estimate was 592 (95% interquantile range 291-842), which compared well with the registered number of people with diabetes-related amputations in the Netherlands (728). The incidence of end-stage renal disease estimated using the MICADO model was 247 people (95% interquartile range 120-363), which was also similar to the registered incidence in the Netherlands (277 people). MICADO performed well in the validation of macrovascular outcomes of population-based cohorts, while it had more difficulty in reflecting 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-based model, MICADO can be applied for projections as well as scenario analyses to evaluate the long-term (cost-) effectiveness of population-level interventions targeting diabetes and its complications in the Netherlands or similar countries.