The prices paid for increasingly popular vitamin D tests vary dramatically across Canada, suggesting some provinces aren't getting the best deal for taxpayers.
In B.C., the province pays $93.63 per test. In Ontario, private companies have a list price of $51.70, while hospitals charge $32. Saskatchewan's government lab does the test for $17, although that doesn't include expenses for nurses taking the samples.
The surging demand for vitamin D tests has spurred one of Canada's most rapidly rising medical costs, but it has also highlighted the surprising disparities.
Most of the discrepancies have arisen because the testing industry hasn't lowered prices to reflect improvements in technology that have reduced the costs of performing the analysis, experts say.
Tests used to be done by hand, taking days to complete and costing around $50, says Reinhold Vieth, director of the laboratory at Toronto's Mount Sinai Hospital that pioneered the first large-scale vitamin D testing in Canada in the 1980s. Now, running the tests is automated and done within hours.
"The hospital sector has lowered its price. It's time for the private labs to follow suit," Dr. Vieth said.
Having a vitamin D test - which measures levels of the nutrient in a blood sample - was once rare, confined mainly to elderly people with osteoporosis and children with the bone disease rickets. But demand for it is surging with interest in the sunshine vitamin's purported anti-cancer and other health-promoting benefits. Ontario is now considering restricting access to the tests, after the province's costs for them blew away all budget projections, rising from $4.1-million in 2005 to an estimated $38.8-million last year. The province paid for more than 730,000 tests in 2009.
Ontario isn't alone in its concerns. Last year Newfoundland cut the number of tests it will pay for, and B.C. doctors have been told that otherwise healthy people shouldn't have their blood analyzed for vitamin D levels. Manitoba physicians have been given the same message.
The B.C. price is under review, said Frances Rosenberg, who helps the B.C. Medical Association determine rates for lab tests. Dr. Rosenberg said B.C. recognizes its price doesn't reflect technological improvements and believes the costs are in the $50 range, on par with Ontario.
But in Ontario, there are indications that the listed price may be too high. While the Ministry of Health fee schedule pays $51.70, the Ontario Association of Medical Laboratories, representing private testing companies, says actual revenue per test is closer to $36, based on the large number of evaluations that aren't compensated each year. (Ontario has an annual cap of $645-million for what it will pay private labs for tests, and when that money is exhausted, firms don't receive additional revenue for extra tests.)
The association contends Ontario hospitals present a misleadingly low price because their labs don't include a fair share of the administrative costs of running a hospital. "When they quote the price of a test, they don't include ... the full overhead costs," said Paul Gould, the association's CEO.
But Dr. Vieth said hospitals do include overhead costs in their prices, and constantly compete among themselves to offer lower costs for their tests. The current charge of $32 still allows a profit, he said.