{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:24:56Z","timestamp":1781007896022,"version":"3.54.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"},{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["PharmacoEconomics"],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.1007\/s40273-025-01555-3","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T17:20:08Z","timestamp":1762449608000},"page":"219-231","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["External Validation of the MicroSimulation Core Obesity Model (MS-COM) to Predict Cardiovascular Outcomes, Mortality and Type 2 Diabetes Mellitus Incidence and Assess Cost Effectiveness"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-3659","authenticated-orcid":false,"given":"Christopher G.","family":"Fawsitt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8576-5552","authenticated-orcid":false,"given":"Howard","family":"Thom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2967-5816","authenticated-orcid":false,"given":"David","family":"Aceituno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2951-9741","authenticated-orcid":false,"given":"Alexander","family":"Jarde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3887-4948","authenticated-orcid":false,"given":"Sara","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3220-801X","authenticated-orcid":false,"given":"Christopher","family":"L\u00fcbker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-0678","authenticated-orcid":false,"given":"Edward","family":"Kayongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4763-8891","authenticated-orcid":false,"given":"Edna","family":"Keeney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Foos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"1555_CR1","doi-asserted-by":"crossref","unstructured":"Phelps NH, Singleton RK, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027\u201350.","DOI":"10.1016\/S0140-6736(23)02750-2"},{"issue":"7","key":"1555_CR2","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1111\/obr.12551","volume":"18","author":"GA Bray","year":"2017","unstructured":"Bray GA, Kim KK, Wilding JPH. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715\u201323.","journal-title":"Obes Rev"},{"key":"1555_CR3","unstructured":"World Health Organization. Obesity and overweight. 1 March 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight. Accessed 20 Feb 2025."},{"key":"1555_CR4","doi-asserted-by":"crossref","unstructured":"Ng M, Gakidou E, Lo J, et al. Global, regional, and national prevalence of adult overweight and obesity, 1990\u20132021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025;405(10481):813\u201338.","DOI":"10.1016\/S0140-6736(25)00355-1"},{"issue":"4","key":"1555_CR5","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1080\/00325481.2022.2051366","volume":"134","author":"DB Horn","year":"2022","unstructured":"Horn DB, Almandoz JP, Look M. What is clinically relevant weight loss for your patients and how can it be achieved? A narrative review. Postgrad Med. 2022;134(4):359\u201375.","journal-title":"Postgrad Med"},{"key":"1555_CR6","doi-asserted-by":"crossref","unstructured":"GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223\u201349.","DOI":"10.1016\/S0140-6736(20)30752-2"},{"issue":"9","key":"1555_CR7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-009773","volume":"7","author":"A Okunogbe","year":"2022","unstructured":"Okunogbe A, Nugent R, Spencer G, et al. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022;7(9):e009773.","journal-title":"BMJ Glob Health"},{"issue":"3","key":"1555_CR8","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1002\/osp4.495","volume":"7","author":"S Lopes","year":"2021","unstructured":"Lopes S, Meincke HH, Lamonte M, et al. A novel decision model to predict the impact of weight management interventions: the Core Obesity Model. Obes Sci Pract. 2021;7(3):269\u201380.","journal-title":"Obes Sci Pract"},{"issue":"3","key":"1555_CR9","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s40273-016-0471-3","volume":"35","author":"M Willis","year":"2017","unstructured":"Willis M, Johansen P, Nilsson A, et al. Validation of the economic and health outcomes model of type 2 diabetes mellitus (ECHO-T2DM). Pharmacoeconomics. 2017;35(3):375\u201396.","journal-title":"Pharmacoeconomics"},{"issue":"5","key":"1555_CR10","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1177\/0272989X12454579","volume":"32","author":"DM Eddy","year":"2012","unstructured":"Eddy DM, Hollingworth W, Caro JJ, et al. Model transparency and validation: a report of the ISPOR-SMDM modeling good research practices task force-7. Med Decis Mak. 2012;32(5):733\u201343.","journal-title":"Med Decis Mak"},{"issue":"5","key":"1555_CR11","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1080\/14737167.2018.1501680","volume":"18","author":"B Schwander","year":"2018","unstructured":"Schwander B, Nuijten M, Hiligsmann M, et al. Event simulation and external validation applied in published health economic models for obesity: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2018;18(5):529\u201341.","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"10","key":"1555_CR12","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1007\/s40273-020-00941-3","volume":"38","author":"S Lopes","year":"2020","unstructured":"Lopes S, Johansen P, Lamotte M, et al. External validation of the core obesity model to assess the cost-effectiveness of weight management interventions. Pharmacoeconomics. 2020;38(10):1123\u201333.","journal-title":"Pharmacoeconomics"},{"issue":"2","key":"1555_CR13","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1089\/dia.2006.8.219","volume":"8","author":"E Mueller","year":"2006","unstructured":"Mueller E, Maxion-Bergemann S, Gultyaev D,\u00a0et al. Development and validation of the economic assessment of glycemic control and long-term effects of diabetes (EAGLE) model. Diabetes Technol Ther. 2006;8(2):219\u201336.","journal-title":"Diabetes Technol Ther"},{"key":"1555_CR14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2099","volume":"357","author":"J Hippisley-Cox","year":"2017","unstructured":"Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017;357:j2099.","journal-title":"BMJ"},{"key":"1555_CR15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5019","volume":"359","author":"J Hippisley-Cox","year":"2017","unstructured":"Hippisley-Cox J, Coupland C. Development and validation of QDiabetes-2018 risk prediction algorithm to estimate future risk of type 2 diabetes: cohort study. BMJ. 2017;359:j5019.","journal-title":"BMJ"},{"issue":"15","key":"1555_CR16","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1056\/NEJMoa0806470","volume":"359","author":"RR Holman","year":"2008","unstructured":"Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577\u201389.","journal-title":"N Engl J Med"},{"issue":"9","key":"1555_CR17","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1007\/s00125-013-2940-y","volume":"56","author":"AJ Hayes","year":"2013","unstructured":"Hayes AJ, Leal J, Gray AM, et al. UKPDS outcomes model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30\u00a0year United Kingdom prospective diabetes study: UKPDS 82. Diabetologia. 2013;56(9):1925\u201333.","journal-title":"Diabetologia"},{"issue":"2 Pt 1","key":"1555_CR18","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/S0002-8703(00)90236-9","volume":"139","author":"RB D'Agostino","year":"2000","unstructured":"D\u2019Agostino RB, Russell MW, Huse DM, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000;139(2 Pt 1):272\u201381.","journal-title":"Am Heart J"},{"issue":"11","key":"1555_CR19","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1056\/NEJMoa2032183","volume":"384","author":"JPH Wilding","year":"2021","unstructured":"Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989\u20131002.","journal-title":"N Engl J Med"},{"issue":"24","key":"1555_CR20","doi-asserted-by":"publisher","first-page":"2221","DOI":"10.1056\/NEJMoa2307563","volume":"389","author":"AM Lincoff","year":"2023","unstructured":"Lincoff AM, Brown-Frandsen\u00a0K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221\u201332.","journal-title":"N Engl J Med"},{"issue":"4","key":"1555_CR21","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2400229","volume":"4","author":"Z Yao","year":"2025","unstructured":"Yao Z, Tchang BG, Albert M, et al. Associations between class I, II, or III obesity and health outcomes. NEJM Evid. 2025;4(4):EVIDoa2400229.","journal-title":"NEJM Evid"},{"issue":"6","key":"1555_CR22","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1161\/CIRCULATIONAHA.107.699579","volume":"117","author":"RB D'Agostino Sr","year":"2008","unstructured":"D\u2019Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743\u201353.","journal-title":"Circulation"},{"issue":"1","key":"1555_CR23","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1186\/s12889-021-10606-1","volume":"21","author":"B Iyen","year":"2021","unstructured":"Iyen B, Weng S, Vinogradova Y, et al. Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health. 2021;21(1):576.","journal-title":"BMC Public Health"},{"issue":"11","key":"1555_CR24","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/j.jacc.2013.11.035","volume":"63","author":"B M\u00f8rkedal","year":"2014","unstructured":"M\u00f8rkedal B, Vatten LJ, Romundstad PR, et al. Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Tr\u00f8ndelag Health Study), Norway. J Am Coll Cardiol. 2014;63(11):1071\u20138.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"1555_CR25","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1001\/jama.2011.1914","volume":"307","author":"L Sj\u00f6str\u00f6m","year":"2012","unstructured":"Sj\u00f6str\u00f6m L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56\u201365.","journal-title":"JAMA"},{"issue":"9489","key":"1555_CR26","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/S0140-6736(05)67185-1","volume":"366","author":"B Dahl\u00f6f","year":"2005","unstructured":"Dahl\u00f6f B, Sever PF, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895\u2013906.","journal-title":"Lancet"},{"issue":"26","key":"1555_CR27","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1056\/NEJMoa035622","volume":"351","author":"L Sj\u00f6str\u00f6m","year":"2004","unstructured":"Sj\u00f6str\u00f6m L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10\u00a0years after bariatric surgery. N Engl J Med. 2004;351(26):2683\u201393.","journal-title":"N Engl J Med"},{"key":"1555_CR28","doi-asserted-by":"crossref","unstructured":"Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837\u201353.","DOI":"10.1016\/S0140-6736(98)07019-6"},{"issue":"16","key":"1555_CR29","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1056\/NEJMoa1804988","volume":"379","author":"L Bowman","year":"2018","unstructured":"Bowman L, Mafham M, Wallendszus K, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529\u201339.","journal-title":"N Engl J Med"},{"issue":"9435","key":"1555_CR30","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S0140-6736(04)16895-5","volume":"364","author":"HM Colhoun","year":"2004","unstructured":"Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685\u201396.","journal-title":"Lancet"},{"issue":"2","key":"1555_CR31","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1056\/NEJMoa1212914","volume":"369","author":"RR Wing","year":"2013","unstructured":"Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145\u201354.","journal-title":"N Engl J Med"},{"issue":"9","key":"1555_CR32","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1007\/s11695-014-1567-5","volume":"25","author":"O Borisenko","year":"2015","unstructured":"Borisenko O, Adam D, Funch-Jensen P, et al. Bariatric surgery can lead to net cost savings to health care systems: results from a comprehensive European decision analytic model. Obes Surg. 2015;25(9):1559\u201368.","journal-title":"Obes Surg"},{"issue":"5","key":"1555_CR33","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1007\/s00125-004-1387-6","volume":"47","author":"A Ramachandran","year":"2004","unstructured":"Ramachandran A,\u00a0Snehalatha C, Baskar AD,\u00a0et al. Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia. 2004;47(5):860\u20135.","journal-title":"Diabetologia"},{"issue":"8","key":"1555_CR34","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1007\/s40273-025-01491-2","volume":"43","author":"K Abraham","year":"2025","unstructured":"Abraham K, Corro Ramos I, Braal CL, et al. Under-reporting of validation efforts for health economic models persists despite the availability of validation tools: a systematic review. Pharmacoeconomics. 2025;43(8):849\u201358.","journal-title":"Pharmacoeconomics"},{"issue":"1","key":"1555_CR35","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1411892","volume":"373","author":"X Pi-Sunyer","year":"2015","unstructured":"Pi-Sunyer X, Astrup A, Fuijioka K, et al. A randomized, controlled trial of 3.0\u00a0mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11\u201322.","journal-title":"N Engl J Med"},{"issue":"3","key":"1555_CR36","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1056\/NEJMoa2206038","volume":"387","author":"AM Jastreboff","year":"2022","unstructured":"Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205\u201316.","journal-title":"N Engl J Med"},{"issue":"10","key":"1555_CR37","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1007\/s40273-025-01520-0","volume":"43","author":"B Pennington","year":"2025","unstructured":"Pennington B, Cummins E, Chandler A, et al. Challenges in modelling the cost effectiveness of pharmacotherapies for obesity. Pharmacoeconomics. 2025;43(10):1171\u20138.","journal-title":"Pharmacoeconomics"}],"container-title":["PharmacoEconomics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40273-025-01555-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40273-025-01555-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40273-025-01555-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:35:19Z","timestamp":1769783719000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40273-025-01555-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["1555"],"URL":"https:\/\/doi.org\/10.1007\/s40273-025-01555-3","relation":{},"ISSN":["1170-7690","1179-2027"],"issn-type":[{"value":"1170-7690","type":"print"},{"value":"1179-2027","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"assertion":[{"value":"6 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Christopher L\u00fcbker and Sara Larsen are employees and shareholders of Novo Nordisk A\/S. Howard Thom owns shares in the consulting company Clifton Insight, and Alexander Jarde, David Aceituno, Edward Kayongo, Edna Keeney and Christopher G. Fawsitt are employees of Clifton Insight, which has received fees from Amicus, Baxter, Bayer, Daiichi-Sankyo, Eisai, Lundbeck, Merck, Novartis, Novo Nordisk, Pfizer, Roche and UCB. Volker Foos has received consulting fees from Novo Nordisk A\/S but not for his participation in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest\/Competing Interests"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Material"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code Availability"}},{"value":"All authors contributed to the drafting and editing of the manuscript. CL, SL, VF and HT, conceptualised the methods for validation. CGF, HT, CL, SL, EK and VF contributed to the validation exercises. All authors contributed to the systematic review. All authors read and approved the final version of the manuscript.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 Contributions"}}]}}