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Vitamin D tablets: How much testing is necessary?

Roger Hallett/The Globe and Mail

The Ontario government has decided to no longer cover the cost of most vitamin D tests, a popular evaluation that has become one of the most frequently ordered medical tests in the province.

The Ministry of Health posted the change - it takes effect Dec. 1 - on its website Tuesday with little fanfare. It said it made the decision because the tests, which cost about $50 each and analyze blood for the amount of vitamin D it contains, aren't necessary for most people.

With the huge interest by doctors and their patients in the purported health benefits of the sunshine vitamin, the tests have been one of the most rapidly growing sources of upward cost pressure in the health-insurance system. The number ordered by doctors rose to about 700,000 last year from 29,000 in 2004, according to the ministry.

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The government's decision was issued just days before an expert panel jointly commissioned by Health Canada and the U.S. Department of Health will release a report evaluating the health claims about vitamin D and whether current intake guidelines need to be revised.

The panel is reviewing recent medical evidence on the possible connection between low vitamin D intake and risk of cancer, heart disease, diabetes and other chronic illnesses.

The delisting decision disappointed doctors who have been using the tests to monitor vitamin D levels in patients. Those doctors argue it isn't possible to set accurate doses without tracking the amount people have and how they metabolize the nutrient.

"I'm very upset about it," said Linda Rapson, past chairwoman of the complementary medicine section of the Ontario Medical Association. "It's very retrogressive."

The province will continue covering the cost of the test for a small number of conditions, including rickets, osteoporosis and kidney disease.

The province pays laboratories a fixed amount of $649-million a year for all medical tests. The rapid surge in the number of vitamin D tests doesn't immediately drive up health-care costs, but has been eroding the profit margins at testing companies, which temporarily have absorbed the extra expenses of unexpectedly high numbers of the evaluations.

The Ministry of Health previously estimated that if current trends continue, by 2012 vitamin D tests could cost it about $150-million annually.

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