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Validation of the IHE Cohort Model of Type 2 Diabetes and the Impact of Choice of Macrovascular Risk Equations

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  • Adam Lundqvist
  • Katarina Steen Carlsson
  • Pierre Johansen
  • Emelie Andersson
  • Michael Willis

Abstract

Background: Health-economic models of diabetes are complex since the disease is chronic, progressive and there are many diabetic complications. External validation of these models helps building trust and satisfies demands from decision makers. We evaluated the external validity of the IHE Cohort Model of Type 2 Diabetes; the impact of using alternative macrovascular risk equations; and compared the results to those from microsimulation models. Methods: The external validity of the model was analysed from 12 clinical trials and observational studies by comparing 167 predicted microvascular, macrovascular and mortality outcomes to the observed study outcomes. Concordance was examined using visual inspection of scatterplots and regression-based analysis, where an intercept of 0 and a slope of 1 indicate perfect concordance. Additional subgroup analyses were conducted on ‘dependent’ vs. ‘independent’ endpoints and microvascular vs. macrovascular vs. mortality endpoints. Results: Visual inspection indicates that the model predicts outcomes well. The UKPDS-OM1 equations showed almost perfect concordance with observed values (slope 0.996), whereas Swedish NDR (0.952) and UKPDS-OM2 (0.899) had a slight tendency to underestimate. The R2 values were uniformly high (>0.96). There were no major differences between ‘dependent’ and ‘independent’ outcomes, nor for microvascular and mortality outcomes. Macrovascular outcomes tended to be underestimated, most so for UKPDS-OM2 and least so for NDR risk equations. Conclusions: External validation indicates that the IHE Cohort Model of Type 2 Diabetes has predictive accuracy in line with microsimulation models, indicating that the trade-off in accuracy using cohort simulation might not be that large. While the choice of risk equations was seen to matter, each were associated with generally reasonable results, indicating that the choice must reflect the specifics of the application. The largest variation was observed for macrovascular outcomes. There, NDR performed best for relatively recent and well-treated patients, while UKPDS-OM1 performed best for the older UKPDS cohort.

Suggested Citation

  • Adam Lundqvist & Katarina Steen Carlsson & Pierre Johansen & Emelie Andersson & Michael Willis, 2014. "Validation of the IHE Cohort Model of Type 2 Diabetes and the Impact of Choice of Macrovascular Risk Equations," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-12, October.
    • Handle: RePEc:plo:pone00:0110235
    DOI: 10.1371/journal.pone.0110235
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    References listed on IDEAS

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    1. David M. Eddy & William Hollingworth & J. Jaime Caro & Joel Tsevat & Kathryn M. McDonald & John B. Wong, 2012. "Model Transparency and Validation," Medical Decision Making, , vol. 32(5), pages 733-743, September.
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    1. Michael Laxy & Verena Maria Schöning & Christoph Kurz & Rolf Holle & Annette Peters & Christa Meisinger & Wolfgang Rathmann & Kristin Mühlenbruch & Katharina Kähm, 2019. "Performance of the UKPDS Outcomes Model 2 for Predicting Death and Cardiovascular Events in Patients with Type 2 Diabetes Mellitus from a German Population-Based Cohort," PharmacoEconomics, Springer, vol. 37(12), pages 1485-1494, December.
    2. Michael Willis & Adam Fridhammar & Jens Gundgaard & Andreas Nilsson & Pierre Johansen, 2020. "Comparing the Cohort and Micro-Simulation Modeling Approaches in Cost-Effectiveness Modeling of Type 2 Diabetes Mellitus: A Case Study of the IHE Diabetes Cohort Model and the Economics and Health Out," PharmacoEconomics, Springer, vol. 38(9), pages 953-969, September.
    3. Michael Willis & Pierre Johansen & Andreas Nilsson & Christian Asseburg, 2017. "Validation of the Economic and Health Outcomes Model of Type 2 Diabetes Mellitus (ECHO-T2DM)," PharmacoEconomics, Springer, vol. 35(3), pages 375-396, March.
    4. Åsa Ericsson & Divina Glah & Maria Lorenzi & Jeroen P Jansen & Adam Fridhammar, 2018. "Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-16, February.
    5. Pierre Johansen & Jonas Håkan-Bloch & Aiden R. Liu & Peter G. Bech & Sofie Persson & Lawrence A. Leiter, 2019. "Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada," PharmacoEconomics - Open, Springer, vol. 3(4), pages 537-550, December.
    6. Åsa Ericsson & Adam Lundqvist, 2017. "Cost Effectiveness of Insulin Degludec Plus Liraglutide (IDegLira) in a Fixed Combination for Uncontrolled Type 2 Diabetes Mellitus in Sweden," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 237-248, April.

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