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

Diabet Med. 2015 Dec;32(12):1580-7. doi: 10.1111/dme.12811. Epub 2015 Jun 15.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Amputation / adverse effects
  • Amputation / economics
  • Blindness / complications
  • Blindness / economics
  • Blindness / epidemiology
  • Blindness / therapy
  • Clinical Trials as Topic
  • Cohort Studies
  • Combined Modality Therapy / economics
  • Computer Simulation
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / prevention & control
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / economics
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / prevention & control*
  • Diabetic Angiopathies / therapy
  • Diabetic Nephropathies / economics
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / prevention & control
  • Diabetic Nephropathies / therapy
  • Health Care Costs
  • Health Policy*
  • Humans
  • Incidence
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy
  • Models, Cardiovascular*
  • Models, Economic*
  • Mortality
  • Netherlands / epidemiology
  • Peripheral Vascular Diseases / complications
  • Peripheral Vascular Diseases / economics
  • Peripheral Vascular Diseases / epidemiology
  • Peripheral Vascular Diseases / therapy
  • Prevalence
  • Quality of Life*
  • Risk Factors
  • Vascular Diseases / economics
  • Vascular Diseases / epidemiology
  • Vascular Diseases / prevention & control*
  • Vascular Diseases / therapy