CONCLUSION: When compared to other antiviral therapies, tenofovir therapy is a cost-effective strategy in preventing chronic hepatitis B infection in infants born to highly viremic hepatitis B-infected mothers. 457 Labor induction at 38 weeks versus expectant management of insulin-requiring diabetics in pregnancy: a cost effective analysis Unzila Nayeri 1 , Sammy Tabbah 2 , Erika Werner 3 , Christian Pettker 4 , Mark Landon 2 , Stephen Thung 2 1 SUNY Upstate Medical Center, Department of Obstetrics and Gynecology, Syracuse, NY, 2 Ohio State University College of Medicine, Division of Maternal-Fetal Medicine, Columbus, OH, 3 Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, 4 Yale University, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT OBJECTIVE: Currently, there is no uniform recommendation for timing of delivery in pregnant patients with insulin-requiring dia- betes mellitus (DM). The objective of this study was to determine if labor induction at 38 weeks gestation is cost effective when compared to expectant management. STUDY DESIGN: We developed a decision analysis model to compare the cost effectiveness of two strategies during pregnancy in women with insulin-requiring DM: (1) expectant management (EM) and (2) induction of labor at 38 weeks gestation (IOL). We considered risks of cesarean delivery (CD), preeclampsia, neonatal respiratory distress (RDS) and chronic lung disease (CLD), stillbirth (IUFD), neonatal demise (NND), shoulder dystocia (SD), and transient and perma- nent brachial plexus injuries (BPI). We assumed that the risk of CD was similar for both strategies, as previously demonstrated by a randomized trial, and that the risk of SD was lower with IOL (1.4% versus 3%). The main outcome measure was incremental cost- effectiveness ratio (ICER) defined as marginal cost per quality- adjusted life year (QALY) gained. An ICER <$100,000/QALY gained was considered cost effective. Sensitivity analyses and Monte Carlo simulations were performed. RESULTS: Our model demonstrates that for every 100,000 pregnan- cies complicated by insulin-requiring DM, IOL at 38 weeks results in an additional 100 QALYs gained at a cost of $2,069,000, which translates to an ICER of $20,069/QALY gained. For every 100,000 pregnancies, IOL at 38 weeks would prevent 42 IUFD and 14 per- manent BPI and would result in an additional 9 NND and 100 CLD. The model remains robust in univariate sensitivity analyses. The model is most sensitive to probabilities of NND, RDS, and SD. Monte Carlo simulation demonstrates that IOL is either the domi- nant or more cost effective strategy 87% of the time. CONCLUSION: In pregnant patients with insulin-requiring DM, in- duction of labor at 38 weeks is the cost effective strategy under a wide range of circumstances. 458 Content analysis comparing obstetricians’ and neonatologists’ approaches to periviable counseling Brownsyne Tucker Edmonds 1 , Fatima McKenzie 1 , Richard Frankel 2 1 Indiana University School of Medicine, Obstetrics and Gynecology, Indianapolis, IN, 2 Richard L. Roudebush VA Medical Center, Indianapolis, IN OBJECTIVE: To describe and compare the management options and risks that obstetricians and neonatologists discuss when counseling patients at the threshold of viability. STUDY DESIGN: We conducted an exploratory single-center simula- tion study. Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman presenting with ruptured membranes at 23 weeks gestation. In total, 62 simulation encounters were directly observed and audio and video-recorded. Checklists were completed to assess whether management options (e.g. resuscitation, comfort care, mode of delivery, steroid admin- istration) and their attendant risks/benefits were explained by phy- sicians. Two investigators (BTE, FM) independently rated the encounters. Analyses were conducted with SPSS 20. RESULTS: Our study population consisted of 13 OB/GYN general- ists, 2 MFMs; 2 MFM fellows; 9 neonatologists and 6 neonatology fellows. 53% of providers had graduated from residency within 10 years; 72% were female. Characteristics did not vary across spe- cialty. There were no differences in discussion of steroid admin- istration, risks to baby, or cesarean section. However, obstetricians more frequently discussed the patient’ s diagnosis (p¼.03), maternal risks (p<.001), and, with regards to cesarean, the need for and risks associated with a classical cesarean section (p<.001). Conversely, neonatologists were more likely to discuss short term complications for the baby (p¼.005), survival (p¼.012), and resuscitation and palliative management options (p<.001 and p¼.002, respectively). CONCLUSION: Obstetricians and neonatologists provide complemen- tary counseling content to patients. Joint counseling efforts and/or family meeting models may minimize redundancy and in- consistencies in counseling; and ensure that counseling occurs in adequate depth and breadth to facilitate informed decision-making in periviable care. 459 A comparison of neonatal morbidity and mortality estimates provided by obstetricians and neonatologists in periviable counseling Brownsyne Tucker Edmonds 1 , Fatima McKenzie 1 , Richard Frankel 2 1 Indiana University School of Medicine, Obstetrics & Gynecology, Indianapolis, IN, 2 Richard L. Roudebush VA Medical Center, Indianapolis, IN OBJECTIVE: To describe the variation, across providers and specialty, and range of estimates of neonatal morbidity and mortality told to standardized patients in periviable counseling encounters. STUDY DESIGN: We conducted an exploratory single-center simula- tion study. 16 obstetricians (OBs) and 15 neonatologists each counseled 2 standardized patients portraying pregnant women pre- senting with ruptured membranes at 23 weeks gestation. In total, 62 simulated encounters were audio and video-recorded. Two in- vestigators identified and tabulated all instances of numerically described risk estimates (e.g. probabilities, frequencies) of neonatal mortality and long or short term morbidity, noting the number and range of unique risk estimates described across individuals and by specialty. Analyses were facilitated by NVivo 10. RESULTS: Overall, 14/15 (93%) neonatologists utilized numeric es- timates; 7/16 (44%) OBs did. OBs frequently deferred the discussion of “exact numbers” to neonatologists. 13/14 neonatologists provided numeric estimates ranging from 3% to 50% survival. Neonatologists provided 13 unique estimates; 5 neonatologists provided 2-3 different estimates in a single encounter. Only 2/14 (14%) neo- natologists provided estimates of intact survival, and another 2 gave estimates of long-term disability; 5/7 OBs provided 3 unique survival Poster Session III Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues www.AJOG.org S230 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014