BRAVO Model
Information last updated: Feb 2019
Participated in following Mt Hood Diabetes Challenge Meetings: 2018
Publicly accessible?: Not at this stage.
Is the model continuing to be developed?: Yes.
Brief Description:
The BRAVO diabetes model is a patient-level discrete-event microsimulation model. The core calculation risk engine contains 3 separate modules (events module, risk factors module, and mortality module), each of which contains a series of regression equations to predict the occurrence of events, progression in risk factors, and mortality. Specifically, a total of 17 risk equations for predicting diabetes-related microvascular and macrovascular events (8 equations), hypoglycemia (2 equations), mortality (2 equations), and progression of diabetes risk factors (5 equations) are estimated using the data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (n=10,251 patients). In the events module, a series of risk equations were fitted to predict diabetes related macrovascular events (stroke, MI, CHF, angina, and revascularization surgery), microvascular events (ESRD, blindness, and sever pressure sensation loss) and adverse events (severe hypoglycemia and symptomatic hypoglycemia). In the risk factors module, each risk factor (HbA1c, SBP, Weight, and LDL) in the current cycle was predicted jointly by its value from last cycle and other risk factors. Lastly, in the mortality module, an equation was fitted to predict patient death, and a second equation was developed to explore the cause of death (i.e. CVD or other death causes).
Explanatory variables can be categorized into three groups: biomedical factors (HbA1c, SBP, LDL, BMI), demographic characteristics (Age, diabetes duration, sex, education, smoker, race), and complications (current event or history). Therefore, the BRAVO model can be used as both primary and secondary prevention risk calculators. The BRAVO model has been validated internally and externally and is further calibrated for population outside of the United States.
Funding source for model development:
No specific funding.
Key Publications:
Manuscript on risk engine is currently under review.
Reference simulation
The values below are simulated Quality Adjusted life Years (QALYs) for a set of reference simulations
Model | Sex | Control | 0.5% red. HbA1c | 10mmHg in SBP | 0.5mmol/l red. LDL | 1-unit red BMI | All combined | Date |
|---|---|---|---|---|---|---|---|---|
BRAVO Diabetes Model | Male | 10.44 | 10.67 | 10.75 | 10.61 | 10.63 | 11.3 | 5/10/2018 |
BRAVO Diabetes Model | Female | 11.81 | 12.1 | 12.22 | 12.04 | 12.03 | 12.89 | 5/10/2018 |