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Cover of Vitamin D Testing in the General Population: A Review of the Clinical and Cost-Effectiveness and Guidelines

Vitamin D Testing in the General Population: A Review of the Clinical and Cost-Effectiveness and Guidelines

Rapid Response Report: Summary with Critical Appraisal

Rising awareness about the potential link between vitamin D deficiency and adverse health outcomes has seen an increase in the rate of vitamin D testing in developed countries. The cost of a single vitamin D test is moderate (e.g., $61.32 in British Colombia) but the elevated testing rate contributes to substantial healthcare costs. Concern over rising costs led to reform in testing coverage in 2010 in Ontario, followed by other provinces. The changes in Ontario were based on a 2010 report by the Ontario Health Technology Advisory Committee (OHTAC) on the clinical utility of vitamin D testing (reviewed in this report). Despite a lack of direct evidence on testing, a recommendation was made against providing testing for the general population. Tests are now indicated only for individuals with specific conditions (i.e., osteoporosis, rickets, osteomalacia, malabsorption syndromes, renal disease, and individuals taking medications that may affect vitamin D status). The Endocrine Society and Osteoporosis Canada also recommend against screening for low risk individuals. There is a lack of evidence to suggest that the rise in test frequency has translated into improved healthcare practices. For example, the temporal increase in testing in Australia has not resulted in improved osteoporosis detection in women aged 45 to 74. There is also a lack of evidence on the cost-effectiveness of testing. In light of the rise in test frequency, assay and cut-off inconsistency, and the lack of evidence for the utility of testing, this report will investigate the clinical and cost-effectiveness of testing in the general population.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

Copyright © 2015 Canadian Agency for Drugs and Technologies in Health.

Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK274106PMID: 25674654

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