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The aim of this study is to develop a patient-level model for type 2 diabetes mellitus (T2DM) progression that can estimate the cost-effectiveness of T2DM interventions from prevention to management.
Methods
We developed an individual-level microsimulation model, the Institute of Health Economics Diabetes Model (IHE-DM), that simulates: (i) T2DM progression from normal glucose tolerance (NGT) to T2DM, (ii) the occurrence and timing of eight comorbidities and death, and (iii) the correlated progression of risk factors over time. We report model validation and use a case study to investigate the cost-effectiveness of a hypothetical T2DM prevention program.
Results
The internal validation indicated excellent performance with mean absolute differences between the predicted and observed values for all endpoints of less than 1 percent. External validation results were mixed. The model under-predicted cumulative T2DM incidence in the first 8 years, predicted well from years eight through eleven, and over-predicted from years twelve through fifteen. Our case study estimated an incremental net monetary benefit of CAD 2,701 (USD 2,289) (95% Uncertainty Interval: CAD 1,316 to 4,000 [USD 1,115 to 3,390]) over the 15-year time horizon.
Conclusions
Prominent T2DM models focus on patients with diagnosed T2DM whereas our model simulates progression from NGT to T2DM and incorporates important correlations in the progression of risk factors. These adaptations allow us to evaluate preventative interventions and better capture the long-term impacts, filling an important gap in the evidence base. Our model can be used to inform future funding decisions for T2DM interventions across the care continuum.
Behavioural complexity is likely to reflect how animals cope with their environment. A large behavioural repertoire and the ability to flexibly apply these behaviours provide an individual with a greater likelihood of adapting to its (captive) environment. Here, we developed a procedure to aggregate different behavioural measures into a condensed measure of behavioural complexity based on 14 features, which were previously proposed (e.g. number of behaviours, Shannon diversity index) as well as some new features of behavioural complexity (e.g. variances of within and between transition durations). To test the measure, artificial behavioural sequences with potentially varying complexity were created using an individual-based modelling approach. With a Principal Component Analysis, the features extracted from these sequences could be reduced to two components (‘general complexity’ and ‘state variability’) explaining 59.64 and 27.68% of the total variance, respectively. The effect of the aspects of the artificial behavioural sequences on ‘general complexity’ and ‘transitions variability’ were analysed using linear mixed-effects models. The number of behavioural categories and the proportion of short behavioural states had the largest effect on the components. Both components were increasing with a greater number of behavioural categories, whereas the proportion of short behavioural states the opposite effect on the components. We also tested the approach on real data-sets. The principle components were not identical to the ones from the simulation. Yet, we found consistencies and similarities in the loadings. The approach for an aggregated measure of behavioural complexity developed here could form the basis of an individual-based animal welfare indicator for intensively kept animals.
Proponents of a basic income (BI) claim that, on top of many other benefits, it could bring significant reductions in financial poverty. Using microsimulation analysis in a comparative two-country setting, we show that the potential poverty-reducing impact of BI strongly depends on exactly how and where it is implemented. Implementing a BI requires far more choices than advocates seem to realise. The level at which a BI is set matters, but its exact specification matters even more. The impact of a BI, be it a low or a high one, also strongly depends on the characteristics of the system that it is (partially) replacing or complementing, as well as the socio-economic context in which it is introduced. Some versions of BI could potentially help to reduce poverty but always at a significant cost and with substantial sections of the population incurring significant losses, which matters for political feasibility. A partial BI complementing existing provisions appears to make more potential sense than a full BI replacing them. The simplicity of BI, however, tends to be vastly overstated.
Diets closer aligned with nutritional guidelines could lower the risk of several chronic conditions and improve economic outcomes, such as employment and healthcare costs. However, little is known about the range, order of magnitude and timing of these potential effects.
Design:
We used a microsimulation approach to predict US population changes over 30 years in health and economic outcomes that could result from a substantial (but not impossible) improvement in diet quality – an improvement from the third to the fifth quintile of US scores on the Alternate Healthy Eating Index, 2010 version.
Setting:
Risk ratios from the literature for diabetes, heart disease and stroke were used to modify the Future Adult Model (FAM) to simulate outcomes from a higher-quality diet. Model parameter uncertainty was assessed using bootstrap and sensitivity analysis examined the variation in published risk ratios.
Participants:
FAM simulates outcomes for the US adult population aged 25 and older.
Results:
Improved diet quality initially leads to very small changes in chronic disease prevalence, but these accumulate over time. If diets improved beginning in 2019, after 30 years diabetes prevalence could be reduced by 5·9 million cases (11·5 %), heart disease prevalence by 4·0 million cases (7·2 %) and stroke prevalence by 1·9 million cases (10·3 %). These reductions in disease prevalence would be accompanied that same year by fewer deaths (88 000) and healthcare cost savings of $144·0 billion (2019 USD).
Conclusions:
This microsimulation study suggests that improvements in diet are likely to improve health and economic population outcomes over time.
Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them.
Due to structural and policy shifts, pension deficit in North Macedonia doubled over a decade and significantly outpaced the central budget deficit. The objective of the paper is to examine fiscal and development effects of few pension-reform designs. We constructed MK-PENS Dynamic Microsimulation Pension Model and simulated the effects of few reforms affecting one stakeholder and few combined reforms. Results robustly suggest that without reform and assuming only statutory pension adjustment, the deficit will remain as is. Simulated scenarios suggest that proposed pension reforms significantly reduce the pension deficit, with the most favourable results obtained within the combined scenarios of shared burden. Gradual introduction of reform's elements should come into play in case large political cost is envisaged.
Inclusion of additional dimensions to population projections can lead to an improvement in the overall quality of the projections and to an enhanced analytical potential of derived projections such as literacy skills and labor force participation. This paper describes the modeling of educational attainment of a microsimulation projection model of the European Union countries. Using ordered logistic regressions on five waves of the European Social Survey, we estimate the impact of mother's education and other sociocultural characteristics on educational attainment and implement them into the microsimulation model. Results of the different projection scenarios are contrasted to understand how the education of the mother and sociocultural variables may affect projection outcomes. We show that a change in the impact of mother's education on children's educational attainment may have a big effect on future trends. Moreover, the proposed approach yields more consistent population projection outputs for specific subpopulations.
It has been long suggested that public pension wealth may crowd out household savings. However, there remains controversy about the extent of this displacement effect. In this paper we use an original microsimulation model based on retrospective survey data collected through the third wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to estimate the displacement effect of public pension wealth on other wealth in Belgium. Combining this rich dataset with an accurate estimation of the individual pension entitlements allows us to circumvent some of the main measurement error problems faced by previous studies. We estimate that an extra euro of public pension wealth is associated with about 14–25 cent decline in households’ non-pension wealth.
Population aging is the population issue of the XXI century and many indices are used to measure its level and pace. In Science (2010), Sanderson and Scherbov suggested improvements to the measure of elderly dependency ratio. They identified several limitations to the use of chronological age as the main variable and proposed a new index, the Adult Disability Dependency Ratio, defined as the number of adults at least 20 years old with disabilities divided by the number of similarly aged adults without disabilities. They used the Sullivan prevalence-based method by multiplying derived disability rates to macro population projections. They showed results for several ECE and OECD countries; results for Canada (see online annex, available at https://www.sciencemag.org/content/329/5997/1287/suppl/DC1) were derived using coefficients of Italy. However, disability is a complex multidimensional process (see Carrière, Keefe, Légaré, Lin, & Rowe, 2007; Légaré and Décarie, 2011), and microsimulation can take into account its implied complexity. Our results for Canada, presented here, exceed those in Science to show how more-sophisticated projections of disabled older adults can improve the analysis. We used LifePaths, a Statistics Canada’s microsimulation model, to provide a perspective of the phenomena unobtainable with prevalence-based methods.
Dans la perspective d'une stratégie de réduction de la pauvreté et l'atteinte des Objectifs du Millénaire pour le Développement, une littérature sur la croissance pro-pauvre s'est développée depuis une quinzaine d'années. Toutefois, les analyses d'impact sur la pauvreté des réformes sont appliquées en équilibre partiel et abordent peu l'efficacité et l'équité conjointement. De plus, elles s'intéressent rarement aux interactions entre les politiques envisagées. Nous abordons ces questions à travers une application d'un modèle d'équilibre général calculable de type macro/micro aux Philippines dans lequel nous générons de la croissance par l'endogénéisation de l'offre de travail et les externalités des dépenses publiques. Les résultats mitigés obtenus des simulations de réformes illustrent l'importance de la prise en compte des spécificités et du contexte particulier de chaque pays dans la mise en œuvre des réformes.
Smoking is one of the major causes of premature death and its negative effects on a person's health are a global issue. Therefore, the United Kingdom has introduced new policies aimed at reducing the proportion of smokers from 26% in 2005 down to 21% by 2010. One mechanism to meet this policy target is the provision of stop smoking services. This article aims to estimate the Leeds smoking population at the small area level and especially to highlight the distribution of hard-to-reach groups such as heavy smokers (> 20 cigarettes/day) and pregnant women who smoke. Then optimal location strategies are discussed in relation to stop smoking services. The findings show the importance of adding a spatial component to find out where the smoking population or specific subgroups of smokers are to support policymakers or healthcare planners who are responsible for the planning process of the services.
We analyse the impact of various pension regimes, as shaped by recent Italian reforms, on retirement age, adequacy issues, and redistribution. We add to the literature on microsimulation by accounting for individuals' reactions to financial incentives when deciding to retire. We find that shifting from a generous defined benefit (DB) system to an actuarially fair notional defined contribution (NDC) system induces individuals, particularly men, to postpone retirement. Voluntary postponement of retirement would grant employees a replacement rate comparable to that obtained in the pre-reform DB regime, while the self-employed experience a substantial reduction in their replacement rate.
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