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. What's new? The MICADO model is a validated dynamic population model that follows overlapping cohorts of people with diabetes as they age over time. MICADO's incidence and prevalence of complications and mortality risks were estimated from representative national registries, systematic literature reviews and trial data, resulting in a model that reflects a typical diabetes population and the effects of treatment in daily practice. MICADO can be used for disease projections and the evaluation of policy scenarios regarding long‐term effects on morbidity, mortality, quality of life and costs.