SPHR Diabetes


Contact: Penny Breeze

Last updated: Feb 2019

Participated in following Mt Hood Diabetes Challenge meetings: 2018



The SPHR Diabetes Prevention model is an individual patient simulation model programmed in R. It was developed to evaluate public health interventions to prevent diabetes and cardiovascular disease in the United Kingdom. The model can be used to estimate the long-term costs, life years and QALYs gain in diabetic or non-diabetic populations.

The model combines data from a number of sources to describe longitudinal risk factor trajectories and multiple complications and comorbidities relating to diabetes. BMI, HbA1c, systolic blood pressure, Total and HDL cholesterol trajectories have been estimated based on longitudinal data from the Whitehall II study. After progression to diabetes HbA1c trajectories are estimated using the UKPDS outcomes model.


A three stage diabetes treatment regimen is applied in the model. At diagnosis all patients are prescribed low cost treatments. If HbA1c increases above 7.4% the individual is prescribed the more expensive Gliptins in addition to Metformin. The individual continues to receive insulin above a threshold of 8.5%. Individuals receive opportunistic screening for hypertension and cardiovascular risk.


Cardiovascular events are estimated using the QRISK2 risk score to be representative of the UK population. In addition the risk of cardiovascular disease was assumed to increase with HbA1c for test results greater than 6.5 to reflect observations from the UKPDS. Microvascular events are estimated from the UKPDS2 outcomes model.  Other outcomes include Congestive Heart Failure, Breast cancer, Colorectal cancer, osteoarthritis and depression, cardiovascular mortality, cancer mortality and all-cause mortality. All health events incur costs and utility decrements.


Key Publications:


Breeze P, Squires H, Chilcott J, Stride C, Diggle PJ, Brunner E, Tabak A, Brennan A. (2015) A statistical model to describe longitudinal and correlated metabolic risk factors: the Whitehall II prospective study. Journal of Public Health. [Epub ahead of print].


Breeze PR, Thomas C, Squires H, Brennan A, Greaves C, Diggle PJ, Brunner E, Tabak A, Preston L, Chilcott J (2015) Impact of Type 2 diabetes prevention programmes based on risk identification and lifestyle intervention intensity strategies: a cost-effectiveness analysis. Diabetic Medicine. [2015: Retracted ]

Reference simulation

The values below are simulated Quality Adjusted life Years (QALYs) for a set of reference simulations