Background Dutch Diabetes Model

The Dutch version of the Diabetes Micro-Simulation model is an adapted version of the well-documented generation of diabetes models based on the model designed and developed by the Eastman’s group (1997). There is a technical manual available for the JAMA editors and reviewers from the authors describing the equations as well as a micro-simulation spreadsheet.

The US version has been used, tested, and adapted by Eastman himself, also by Brown (2000) while others used the equations in various country studies (e.g. Caro, 2004). More recently, this approach has been updated in a project of the CDC Cost-effectiveness Group, reported in the JAMA (2002). The JAMA article reports extensively the original and adapted equations and structural adaptations.

The present Dutch version has been used extensively in the past decade, with separate articles by Niessen and colleagues, describing the change in input values, complication-specific approaches, their external validation results and other articles describing original data collection, integrated analyses, and additional validation results (see references below). The original equations to compute the potential effect of Hb1Ac reductions on the risk of long-term micro-complications are maintained. However, this is of less relevance for the present evaluation paper, as the trial did not measure a significant difference in HbA1c between the two arms. The article by Dijkstra et al. (2006) describes the incorporation of the UKPDS equations to compute cardiovascular events, in particular the excess cardiovascular mortality reduction. The Figure below shows this structural incorporation of the UKPSD equations that replace the original Framingham equations in relation to cardiovascular mortality and cardiovascular events.

The adaptations in relation to the economic evaluation of the quality improvement collaborative strategy are described in the manuscript. The main methodological change is that individual patients records from both trial arms are used as entry in the micro-simulations, including in the UKPSD equation. The spreadsheet model in Excel is available from the authors and needs an @Risk add-on, like the original Eastman version.


Figure. Diabetes Micro-Simulation Model, adapted for Dutch diabetes population

References Diabetes Micro-Simulation Model for US situation

  1. Brown JB, Palmer AJ, Bisgaard P, Chan W, Pedula K, Russell A.The Mt. Hood challenge: cross-testing two diabetes simulation models. Diabetes Res Clin Pract. 2000 Nov;50 S57-64.
  2. Brown JB, Russell A, Chan W, Pedula K, Aickin M. The global diabetes model: user friendly version 3.0. Diabetes Res Clin Pract. 2000 Nov;50 S15-46. Technical report.
  3. Caro JJ, Salas M, O'Brien JA, Ishak K, Sung J, Raggio G. Modeling the efficiency of reaching a target intermediate end point: a case study in type 2 diabetes in the United States.Value Health. 2004 Jan-Feb;7(1):13-21.
  4. CDC Diabetes Cost-effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA. 2002 May 15;287(19):2542-51.
  5. Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Copley-Merriman C, Maier W, Dong F, Manninen D, Zbrozek AS, Kotsanos J, Garfield SA, Harris M. Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care. 1997 May;20(5):735-44. Technical Manual is available.
  6. Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Zbrozek AS, Dong F, Manninen D, Garfield SA, Copley-Merriman C, Maier W, Eastman JF, Kotsanos J, Cowie CC, Harris M. Model of complications of NIDDM. I. Model construction and assumptions. Diabetes Care. 1997 May;20(5):725-34.

References Structure & Input Data of Dutch version Diabetes Micro-Simulation Model

  1. Dijkstra RF, Niessen LW, Braspenning JC, Adang E, Grol RT. Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis. Diabet Med. 2006 Feb;23(2):164-70.
  2. Hutubessy R, Niessen LW Dijkstra R, Casparie AF, Rutten FFH : Stochastic league tables for diabetes treatment in The Netherlands. Health Econ, 2005 May;14(5):445-55.
  3. Niessen LW (2002): Roads to health – multi-state modeling of population health and resource use. Dutch University Press. Book. ISBN no:90 5170 663 4.
  4. Niessen LW and Casparie AT (eds) (2001): Guidelines for diabetes control, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy; effects and costs. Dutch Diabetes Federation (DFN), Dutch Institute for Healthcare Improvement and iMTA, Erasmus University. Van Zuiden Publications.
  5. Niessen LW, Dijkstra R, Hutubessy R, Rutten G, Casparie A: Lifetime health effects and costs of diabetes treatment in The Netherlands Neth J Med 2003 61 355-64. Technical Manual is available.
  6. Ortegon M, Redekop K and Niessen L (2004): Cost-Effectiveness Analysis of Prevention and Treatment of Diabetic Neuropathy: a Markov Simulation Model. Diabetes Care 2004 27(4):901-7.
  7. Os van N, Niessen LW, Bilo HJ, Casparie AF, van Hout BA. Diabetes nephropathy in the Netherlands: a cost effectiveness analysis of national clinical guidelines. Health Policy 2000;51(3):135-47.
  8. Polak BC, Crijns H, Casparie AF, Niessen LW. Cost-effectiveness of glycemic control and ophthalmologic care in diabetic retinopathy. Health Policy 2003;64(1):89-97.
  9. Redekop WK, Koopmanschap MA, Rutten GE, Wolffenbuttel BH, Stolk RP, Niessen LW. Resource consumption and costs in Dutch patients with type 2 diabetes mellitus. Results from 29 general practices. Diabet Med 2002;19(3):246-53.
  10. Redekop WK, Koopmanschap MA, Stolk RP, Rutten GE, Wolffenbuttel BH, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care 2002;25(3):458-63.