Ontario Proposes Evidenced-Based Changes To Vitamin D Testing

August 13, 2010
McGuinty Government Moves Forward On Excellent Care for All Act

Ontario is listening to expert medical advice and proposing to curb unnecessary Vitamin D testing for otherwise healthy people.

In June, Ontario's Health Technology Advisory Committee concluded that the routine use of Vitamin D testing for the general population could not be justified based on current evidence. This builds on other recent medical expert evidence that recommended changes to sleep studies, bone mineral density and pre-operative testing for cataract surgery.

Since 2004, Vitamin D testing has grown by 2,500 per cent - jumping from 29,000 tests to over 700,000 in 2009. Moving toward evidence based testing supports Ontario's Excellent Care for All agenda to ensure health care investments are getting results and improving patient care. The proposed change to Vitamin D testing would result in resources being redirected to other laboratory services.

The province would continue to cover Vitamin D testing for patients where medical evidence indicates there is a need. Ontario would continue to fund tests for patients with medical conditions such as Osteoporosis, Rickets, Osteopenia, Malabsorption Syndromes and Renal Disease. Ontarians who are on medications that affect Vitamin D metabolism would also still be covered.

The public is invited to comment on the proposed change to Vitamin D testing which will be posted on Ontario's regulatory registry until September 26.

In June, Ontario passed the Excellent Care for All Act, which lays the foundation for these improvements and is part of the Open Ontario Plan to improve the quality and value of health care.

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Reasons - clipped from http://www.thestar.com/news/canada/article/847806--ontario-cancels-vitamin-d-testing-for-all?bn=1

Ontario is trying to find ways to curb runaway health costs – 46 per cent of the provincial budget is spent on healthcare.

Not only will cutting vitamin D testing for anyone who asks save the province about $64 million a year Matthews said it will be one less thing for the province’s burdened medical laboratories to deal with.

The health ministry has recently cut some bone mineral density and pre-operative testing for cataract surgery.

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Observation by Vitamin D Wiki admin

1) "This evaluation did not set out to determine the serum vitamin D thresholds that might apply to non-bone health outcomes."
2) The studies looked at were those published before June 2009
3) They only looked at studies in Canada - ignoring the international vitamin D research

Based on the tiny corner of evidence that they considered their I would state their conclusion as"

There were no good Canadian studies published showing Canadian were suffering of bone problems or Kidney disease due to less than 10 ng/ml of vitamin D, thus no vitamin D tests need to be funded.

Also, no evidence had been published which proved that testing for vitamin D will actually cause people to increase the amount of vitamin D that they take.

Here are their files: Feb, updated June, and summary to doctors also in June

• Ontario evidence based analysis - Feb 2010.pdf

from executive summary:

"This evaluation did not set out to determine the serum vitamin D thresholds that might apply to non-bone health outcomes. For bone health outcomes, no high or moderate quality evidence could be found to support a target serum level above 50 nmol/L. Similarly, no high or moderate quality evidence could be found to support vitamin D’s effects in non-bone health outcomes, other than falls."

"The volume of vitamin D tests done in Ontario has been increasing over the past 5 years with a steep increase of 169,000 tests in 2007 to more than 393,400 tests in 2008. The number of tests continues to rise with the projected number of tests for 2009 exceeding 731,000. "

Ontario evidence based analysis - update June 2010 .pdf
"The fact that an optimal vitamin D level to improve bone health outcomes and the risk of falls has not been established undermines the clinical utility of vitamin D testing. Given this important limitation, as well as the limitations of the assays themselves, the routine use of vitamin D testing cannot be justified. Even if there is any residual uncertainty, there is no evidence that testing vitamin D levels encourages adherence to Health Canada’s guidelines. A threshold for vitamin D levels to prevent non-bone health related conditions cannot be established until a causal effect or correlation has been demonstrated between vitamin D and these health conditions. This is as an ongoing research issue around which there is currently too much uncertainty to base any conclusions that would support routine vitamin D testing."

• Ontario guidelines for vitamin D testing - June 2010.pdf
• All items in category Canada 47 items