Cost Assessment for Oncology Patients: Sodium Bicarbonate 2% Oral Solution Mouth Wash for Mucositis

Background: Chemotherapy induced mucositis is one of the deterring factors influencing adherence to cancer treatment. Sodium bicarbonate mouth wash was recently shown to increase patients’ compliance. However, the cost implication of this strategy was never explored. Aim: This study is designed to explore the compounding of sodium bicarbonate 2% mouth wash from sodium bicarbonate powder USP and commercially procured intravenous solution, and to determine the estimated cost implication for patients using this strategy. Materials and Methods: Sodium bicarbonate 2% were compounded using commercially procured sterile intravenous 8.4% solution and powder USP, diluted and dissolved in sterile water for irrigation respectively. The estimated cost savings between the 2 methods were compared to each other as well as to savings from when used in preventing or in adjuvant therapy for chemotherapy induced mucositis. Ethical approval not required by UVA Institutional Review Board. Study conducted according to the International Standards of Good Practice. Result: We came up with a new recipe, sodium bicarbonate 2% mouth wash using commercially procured sterile liquid formulation. Due to shortage, we compounded with sodium bicarbonate powder USP. Using USP 795 regulation, we assigned 14 days beyond use date with refrigeration to these formulations. These formulations resulted in estimated cost savings of $3597.52 and $3686.56 respectively if patients were to be treated for chemotherapy induced mucositis for 21 days. When compared to commercially procured sterile liquid formulation, the use of powder USP, will lead to additional estimated 60 to 66.67% savings for patients. Conclusion: By using sodium bicarbonate powder or solution to compound a 2% mouth wash, we came up with a cheap product that could be used by patients in the moment in the hospital. We were also able to suggest ways that an estimated cost savings for patients undergoing cancer treatment that use this product can be computed.