title: Policy evaluation in diabetes prevention and treatment using a population-based macro simulation model: the MICADO model.
abstract: OBJECTIVE
  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.
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: A A W A
authors.initials: AA
authors.lastname: van der Heijden
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: T L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: R T
authors.initials: RT
authors.lastname: Hoogenveen
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.|School of Medicine, Policy and Practice, University of East Anglia, Norwich, UK.
authors.forename: L W
authors.initials: LW
authors.lastname: Niessen
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: de Bruijne
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Dekker
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Baan
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
mesh_terms: D000671:Amputation, Surgical / Q000009:adverse effects / Q000191:economics; D001766:Blindness / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D003198:Computer Simulation; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008955:Models, Cardiovascular; D018803:Models, Economic; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D014652:Vascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy