In this week’s lecture, ?we discussed the study ?’Five-Hundred Life-Saving Interventions and Their Cost-Effectiveness’, linkDown

Risk Analysis, Vol. 15, No. 3, 1995

Five-Hundred Life-Saving Interventions and Their Cost- Effectiveness

Tammy 0. Tengs,’ Miriam E. Adams,2 Joseph S. Pliskin36 Dana Gelb Safran: Joanna E. Siegel>7 Milton C. Weinstein,G7 and John D. Graham6%’

Received July 26, I994

We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. “Life-saving interventions” were defined as any be- havioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an interven- tion per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention costs $19,OOO/life-year; injury reduction $48,OOO/life-year; and toxin control $2,800,OOO/life-year. CostAife-year ratios and bibliographic references for more than 500 life-sav- ing interventions are provided.

KEY WORDS Cost-effectiveness; economic evaluation; life-saving; resource allocation.

1. INTRODUCTION

Risk analysts have long been interested in strategies that can reduce mortality risks at reasonable cost to the public. Based on anecdotal and selective comparisons, analysts have noted that the cost-effectiveness of risk- reduction opportunities varies enormously, often over several orders of This kind of variation is

Center for Health Policy Research and Education, Duke University, 125 Old Chemistry Building, Box 90253, Durham, North Carolina 27708. Simmons College, School of Social Work, Boston, Massachusetts. Industrial Engineering and Management, Ben-Gurion University of the Negev, Israel. The Health Institute, New England Medical Center, Boston, Massa- chusetts. Maternal and Child Health, Harvard School of Public Health, Boston, Massachusetts.

*Health Policy and Management, Harvard School of Public Health,

unnerving because economic efficiency in promoting survival requires that the marginal benefit per dollar spent be equal across investments.

Despite continuing interest in cost-effectiveness, we could find no comprehensive and accessible data set on the estimated costs and effectiveness of risk management options. Such a dataset could provide useful comparative information for risk analysts as well as practical infor- mation for decision makers who must allocate scarce resources. To this end, we report cost-effectiveness ra- tios for more than 500 life-saving interventions across all sectors of American society.

2. METHODS

2.1. Literature Review Boston, Maskhusetts.

Massachusetts. ’ Center for Risk Analysis, Harvard School of Public Health, Boston, We performed a comprehensive search for publicly

available economic analyses of life-saving interventions.

0272-433u95/0600-0369$07.N1 0 1995 Society for Rhk Analysis 369

370 Tengs e? ul.

“Life-saving interventions’’ were defined as any behav- ioral and/or technological strategy that reduces the prob- ability of premature death among a specified target population. To identify analyses we used several on-line databases, examined the bibliographies of textbooks and review articles, and obtained full manuscripts of confer- ence abstracts. Analyses retained for review met the fol- lowing three criteria: (1) written in the English language, (2) contained information on interventions relevant to the United States, and (3) reported cost per year of life saved, or contained sufficient information to calculate this ratio. Most analyses were scientific journal articles or government regulatory impact analyses, but some were internal government memos, reports issued by re- search organizations, or unpublished manuscripts.

Two trained reviewers (from a total of 11 review- ers) read each document. Each reviewer recorded 52 items, including detailed descriptions of the nature of the life-saving intervention, the baseline intervention to which it was compared, the target population at risk, and cost per year of life saved. The two reviewers worked independently, then met and came to consensus on the content of the document.

Approximately 1200 documents were identified for retrieval. Of these 1200 documents, 229 met our selec- tion criteria. The 229 documents contained sufficient in- formation for reviewers to calculate cost/life-year saved for 587 interventions.

2.2. Definitional Goals

To increase the comparability of cost-effectiveness estimates drawn from different economic analyses, we established seven definitional goals. When an estimate failed to comply with a goal, reviewers attempted to re- vise the estimate to improve compliance? In general, reviewers used only the kformation provided in the doc- ument to revise estimates. The seven definitional goals were:

1. Cost-effectiveness estimates should be in the form of “cost per year of life saved.” CostAife saved estimates should be transformed to costllife-year by considering the average number of years of life saved when a premature death is averted.

Appendices describing the cost-effectiveness formulas used to oper- ationalize these definitional goals, along with some examples of the calculations made by reviewers of the economic analyses, are avail- able from Dr. Tengs.

2. Costs and effectiveness should be evaluated from the societal perspective.

3. Costs should be “direct.” Indirect costs, such as foregone earnings, should be excluded.

4. Costs and effectiveness should be “net.” Any resource savings or mortality risks induced by the intervention should be subtracted out?

5. Future costs and life-years saved should all be discounted to their present value at a rate of 5%.

6. Cost-effectiveness ratios should be marginal or “incremental.” Both costs and effectiveness should be evaluated with respect to a well-de- fined baseline alternative.

7. Costs should be expressed in 1993 dollars using the general consumer price index.

2.3. Categorization

Interventions were classified according to a four- way typology. (1) Intervention Type (Fatal Injury Re- duction, Medicine, or Toxin Control), (2) Sector of So- ciety (Environmental, Health Care, Occupational, Residential, or Transportation), (3) Regulatory Agency (CPSC, EPA, FAA, NHTSA, OSHA, or None), and (4) Prevention Stage (Primary, Secondary, or Tertiary).

Interventions we classified as primary prevention are designed to completely avert the occurrence of dis- ease or injury; those classified as secondary prevention are intended to slow, halt, or reverse the progression of disease or injury through early detection and interven- tion; and interventions classified as tertiary prevention include all medical or surgical treatments designed to limit disability after harm has occurred, and to promote the highest attainable level of functioning among indi- viduals with irreversible or chronic disease.(@

3. RESULTS

Cost-effectiveness estimates for more than 500 life- saving interventions appear in Appendix A. This table is separated into three sections according to the type of intervention: Fatal Injury Reduction, Toxin Control, and Medicine. The first column of Appendix A contains the reference number assigned to the document from which the cost-effectiveness estimate was drawn (references are in Appendix B.) The second column contains a very brief description of the life-saving intervention. The

If savings exceed costs, the result could be negative, so that the cost- effectiveness ratio might be <SO.

Cost-Effectiveness of Saving Lives 371

35% 3

so id id i~ id 10“ 10’ id lop IP ioll coanabyarnved(1993doua)

Fig. 1. Distribution of cosflife-year saved estimates (n = 587).

baseline intervention to which the life-saving interven- tion was compared appears parenthetically as “(vs. – )” when the author described it. The last column of Ap- pendix A contains the cost per year of life saved in 1993 dollars.

As shown in Fig. 1, these interventions range from those that save more resources than they consume, to those costing more than 10 billion dollars per year of life saved. Furthermore, variation over 11 orders of mag- nitude exists in almost every category.

In addition to the large variation within categories, variation in cost-effectiveness also exists between cate- gories. As summarized in Table I, while the median in- tervention described in the literature costs $42,000 per life-year saved (n = 587), the median medical interven- tion costs $19,0OO/life-year (n = 3 10); the median injury reduction intervention costs $48,OOO/life-year (n = 133); and the median toxin control intervention costs $2,800,000Aife-year (n = 144).

Cost-effectiveness also varies as a function of the sector of society in which the intervention is found. For example, as shown in Table I, the median intervention in the transportation sector costs $56,000Aife-year saved (n = 87), while the median intervention in the occupa- tional sector costs $350,000/life-year (n = 36). Further dividing occupational interventions into those that avert fatal injuries and those that involve the control of toxins, reveals medians of $68,000Aife-year (n = 16) and $1,400,000/life-year (n = 20), respectively.

As noted in Table 11, the median cost-effectiveness estimate among those interventions classified as primary prevention is $79,000/life-year saved ( n = 373), ex- ceeding secondary prevention at $23,OOO/life-year (n = 11 1) and tertiary prevention at $22,00O/life-year (n = 103). However, if medicine is considered in isolation, we find that primary prevention is more cost-effective that secondary or tertiary prevention at $5,OOO/life-year (n = 96).

Table I. Median of CoStnife-Year Saved Estimates as a Function of Sector of Society and Type of Intervention

Type of intervention

Fatal injury Toxin Sector of society Medicine reduction control All

Health care $19,000

Residential NIA (n=310)

Transportation N/A

Occupational NIA

Environmental N/A

All $19,000 ( n = 3 10)

NIAa

$36,000 (n=30) $56,000 (n=87) $68,000 (n=16)

NIA

$48,000 (n=133)

N/A

NIA

N/A

$ 1,400,000 (n=20)

$4,200,000 (n=124) $2,800,000 (n=144)

$19,000 (n=310) $36,000 (n = 30) $56,000 (n47)

$350,000 ( ~ 3 6 )

$4,200,000 (n=124) $42,000 (n=587)

a Not applicable by detinition.

Table XI. Median of CoStnife-Year Saved Estimates as a Function of Prevention Stage and Type of Intervention

Type of intervetion

Fatalinjury Toxin Prevention stage Medicine reduction control All

primary $5,000 ( ~ 9 6 )

Secondary $23,000 (n= 11 1)

(n-103) All $19,000

fn-310)

Tertiary $22,000

$48,000 $2,800,000 $79,000 (n=133) (n=144) (n=373) NIA NIA 523,000

(n=lll) NIA N/A $22,000

(n= 103) $48,000 $2,800,000 $42,000 fn=133) (n=1441 (n=587)

The median cost-effectiveness of proposed govem- ment regulations for which we have data also varies con- siderably. Medians for each agency are as follows: Federal Aviation Administration, S23,OOOAife-year (n = 4); Consumer Product Safety Commission, $68,00OAife- year (n = 11); National Highway Traffic Safety Admin- istration, $78,OOO/life-year (n = 3 1); Occupational Safety and Health Administration, $88,0OO/life-year (n = 16); and Environmental Protection Agency, $7,600,000/life-year (n = 89).

4. LIMITATIONS

This compilation of existing data represents the most ambitious effort ever undertaken to amass cost- effectiveness information across all sectors of society. In

Tengs et ul.

addition, our work to bring diverse estimates into com- pliance with a set of definitional goals has improved the comparability of cost-effectiveness estimates that were originally derived by different authors using a variety of methods. Nevertheless, several caveats are warranted to aid the reader in interpreting these results.

First, the accuracy of the results presented herein is limited by the accuracy of the data and assumptions upon which the original analyses were based. There re- mains considerable uncertainty and controversy about the cost consequences and survival benefits of some in- terventions. This is particularly true for toxin control in- terventions where authors often extrapolate from animal data. In addition, due to insufficient information in some economic analyses, reviewers were not always success- 11 in bringing estimates into conformity with defini- tional goals. For example, if the original author did not report the monetary savings due to the reduction in non- fatal injuries requiring treatment, we were unable to “net out” savings, and so the costs used to calculate cost- effectiveness ratios remain gross. While some of these omissions are important, others are largely inconsequen- tial given the relative size of cost and effectiveness es- timates.

Second, the life-saving interventions described in this report include those that are fully implemented, those that are only partially implemented, and those that are not implemented at all. These interventions are best thought of as opportunities for investment. While they may offer insight into actual investments in life-saving, the cost-effectiveness of possible and actual investments are not equivalent. Work on the economic efficiency of actual expenditures is in progressjq

Third, this dataset may not represent a random sam- ple of all life-saving interventions, so the generalizability of any descriptive statistics may be limited. This is be-

cause interventions that have been subjected to economic analysis may not represent a random sample of all life- saving interventions due, for example, to publication bias. That is, those economic analyses that researchers have chosen to perform and journal editors have chosen to publish may be disproportionately expensive or in- expensive. However, the statistics presented herein are certainly applicable to the 587 life-saving interventions in our dataset which by themselves comprise a vast and varied set, worthy of interest even without generaliza- tion.

Finally, we recognize that many of these interven- tions have benefits other than survival, as well as adverse consequences other than costs. For example, interven- tions that reduce fatal injuries in some people may also reduce nonfatal injuries in others; interventions designed to control toxins in the environment may have short-term effects on survival, but also long-term cumulative effects on the ecosystem; medicine and surgery may increase quantity of life, while simultaneously increasing (or even decreasing) quality of life.

5. CONCLUSIONS

This compilation of available cost-effectiveness data reveals that there is enormous variation in the cost of saving one year of life and these differences exist both within and between categories. Such a result is important because efficiency in promoting survival requires that the marginal benefit per dollar spent be the same across programs. Where there are investment inequalities, more lives could be saved by shifting resources. It is our hope that this information will expand the perspective of risk analysts while aiding future resource allocation deci- sions.

Cost-Effectiveness of Saving Lives 373

APPENDIX A. FIVE-HUNDRED LIFE-SAVING INTERVENTIONS AND THEIR COST-EFFECTIVENESS

Ref no.’ Life-saving intervention* Cosfflife-yearc

Fatal injury reduction – ~

Airplane safety 174 Automatic fire extinguishers in airplane lavatory trash receptacles 173 Fiberglass fire-blocking airplane seat cushions 174 Smoke detectors in airplane lavatories 172 Emergency signs, floor lighting etc. (vs. uppn lighting only) in airplanes

Automobile design improvements 190 Install windshields with adhesive bonding (vs. rubber gaskets) in cars 52 Dual master cylinder braking system in cars

1128 Automobile dummy acceleration (vs. side door strength) tests 299 Collapsible (vs. traditional) steering columns in cars 189 Side structure improvements in cars to reduce door intrusion upon crash 52 Front disk (vs. drum) brakes in cars

299 Dual master cylinder braking system in cars

Automobile occupant restraint systems 1129 Driver automatic (vs. manual) belts in cars

59 Mandatory seat belt use law 175 Mandatory seat belt use and child restraint law 67 Driver and passenger automatic shoulder beltknee pads (vs. manual belts) in cars 59 Driver and passengex automatic shoulder/manual lap (vs. manual lap) belts in cars 67 Airbag/mand lap belts (vs. manual lap belts only) in cars 2 Airbagflap belts (vs. lap/shoulder belts)

56 Driver and passenger automatic (vs. manual) belts in cars 1129 Driver airbag/manual lap belt (vs. manual lapkhoulder belt) in cars 1129 Driver and passenger airbagdmanual lap belts (vs. airbag for drivex only and belts)

59 Driver and passenger airbagdmanual lap belts (vs. manual lap belts only) in cars 68 Child restraint systems in cars

I127 Rear outboard lap/shoulder belts in all (vs. 96%) cars 56 Airbags (vs. manual lap belts) in cars

1127 Rear outboard and center (vs. outboard only) laplshoulder belts in all cars

Construction safety 1137 Full (vs. partial) compliance with 1971 safety standard for concrete construction 1137 1988 (vs. 1971) safety standard for concrete construction 909 1989 (vs. no) safety standard for underground construction 909 1989 (vs. 1972) safety standard for underground construction

1132 1989 safety standard for underground gassy construction 1132 Revised safety standard for underground non-gassy construction 106 Install canopies on underground equipment in coal mines 910 Safety standard to prevent cave-ins during excavations at construction sites

1165 Full compliance with 1989 (vs. partial with 1971) safety standard for trenches 1165 Full (vs. partial) compliance with 1971 safety standard for trenches

193 Federal law requiring smoke detectors in homes 13 Fire detectors in homes

306 Federal law requiring smoke detectors in homes 19 Smoke and heat detectors in homes 19 Smoke and heat detectors in bedroom area and basement stairwell

Fire, heat, and smoke detectors

303 Smoke detectors in homes

Fire prevention and protection, other

Flammability standards

122 Child-resistant cigarette lighters

292 Flammability standard for children’s sleepwear size 0-6X 306 Flammability standard for upholstered furniture 292 Flammability standard for children’s sleepwear size 7-14

$ 16,000 $17,000 $30,000 $54,000

s $0 $13,000 $63,000 $67,000

$110,000 $240,000 $450,000

s so $69 $98

$1,300 $5,400 $6,700

$17,000 $32,000 $42,000 $61,000 $62,000 $73,000 $74,000

5120,000 $360,000

s $0 s $0

$30,000 $30,000 $30,000 $46,000

$170,000 3190,000 $350,000 m , 0 0 0

s $0 s $0 $920

$8,100 $150,000 $2 10,000

$42,000

I $0 $300

$45,OOO

314

APPENDIX A. Continued.

Tengs ef al.

~

Ref no." Life-saving intervention* CostAife-yearc

372 Flammability standard for upholstered furniture $68,000 12 Flammability standard for children's sleepwear size 7-14 $160,000

292 Flammability standard for children's clothing size (MX $220,000 292 Flammability standard for children's clothing size 7-14 $15,o00,000

Helmet promotion 31 Mandatory motorcycle helmet laws

186 Federal mandatory motorcycle helmet laws (vs. state determined policies) 175 Mandatory motorcycle helmet laws

1006 Promote voluntary helmet use while riding All-Terrain Vehicles

Highway improvement 747 Grooved pavement on highways

1105 Decrease utility pole density to 20 (vs 40) poles per mile on rural roads 747 Channelized turning lanes at highway intersections 747 Flashing lights at rail-highway crossings 747 Flashing lights and gates at rail-highway crossings 747 Widen existing bridges on highways

1107 Widen shoulders on rural two-lane roads to 5 (vs. 2) feet 1105 Breakaway (vs. existing) utility poles on rural highways 1107 Widen lanes on rural roads to 11 (vs. 9) feet 1105 Relocate utility poles to 15 (vs. 8) feet from edge of highway

Light truck design improvements 1091 Ceilings of 0-6000 Ib light trucks withstand forces of 1.5 X vehicle's weight 1091 Ceilings of 040,000 Ib light trucks withstand forces of 1.5 X vehicle's weight 1091 Ceilings of 0-8500 Ib light trucks withstand forces of 1.5 X vehicle's weight 1091 Ceilings of 0-10,OOO Ib light trucks withstand 5000 Ib of force 1126 Side door strength standard in light trucks to minimize front seat intrusion 1091 Ceilings of (MOO0 Ib light trucks withstand 5000 Ib of force 1126 Side door strength standard in light trucks to minimize back seat intrusion

Light truck occupant restraint systems 1089 Driver and passenger nonmotorized automatic (vs. manual) belts in light trucks 834 Push-button release and emergency locking retractors on truck and bus seat belts

1089 Driver and passenger motorized automatic (vs. manual) belts in light trucks 1089 Driver airbag (vs. manual lap/shoulder belt) in light trucks 1089 Driver and passenger airbags (vs. manual lap/shoulder belts) in light trucks

Natural disaster preparedness 1221 Soils testing and improved site-grading in landslide-prone areas 1221 Ban residential growth in tsunami-prone areas 7 10 Strengthen w i n f o r c e d masonry San Francisco bldgs to LA standards 710 Strengthen w i n f o r c e d masonry San Francisco bldgs to beyond LA standards

1221 Triple the wind resistance capabilities of new buildings 1221 Construct sea walls to protect against 100-year storm surge heights 1221 Strengthen buildings in earthquake-prone areas

School bus safety 1124 Seat back height of 24" (vs. 20") in school buses 1124 Crossing control arms for school buses 1124 Signal arms on school buses 1124 External loud speaken on school buses 1124 Mechanical sensors for school buses 1124 Electronic sensors for school buses 1124 Seat belts for passengers in school buses 1124 Staff school buses with adult monitors

Speed limit 9 National (vs. state and local) 55 mph speed limit on highways and interstates

175 Full (vs. 50%) enforcement of national 55 mph speed limit

I $0 $2,000 $2,000

$44,000

$29,000 $31,000 $39,000 $42,000 $45,000 $82,000

$120,000 $150,000 $150,000 $420,000

$13,000 $14,000 $78,000

$170,000 $190,000

$1,100,000 $ 10,oO0,000

$14,000 $14,000 $50,000 $56,000 $67,000

5 $0 I $0

$2 1 ,000 $ 1 ,000,000 $2,600,000 $5,500,000

$18,000,000

$15O,OoO $410,000 $430,000 $590,000

$1,200,000 $1,500,000 $2,800,000 $4,900,000

$6,600 $ 16,000

Cost-Effectiveness of Saving Lives 375

APPENDIX A. Continued.

Ref no.“ Life-saving interventionb Cosflife-yearc

353 National (vs. state and local) 55 mph speed limit on highways and interstates 185 National (vs. state and local) 55 mph speed limit on highways

2 National (vs. state and local) 55 mph speed limit 185 National (vs. state and local) 55 mph speed limit on rural interstates

Traffic safety education I75 175 175 175 175 175 157 175 175 175 175

1124 175

Vehicle 864

1 I72 864 64 175 175

D&er improvement schools (vs. suspendinghvoking license) for bad drivers Media campaign to increase voluntary use of seat belts Public pedestrian safety information campaign Improve traffic safety information for children grades K-12 Motorcycle rider education program Improve motorcycle testing and licensing system Improve basic driver training Alcohol safety programs for drunk drivers Multimedia retraining courses for injury-prone drivers Improve educational curriculum for beginning drivers First aid training for drivers Improve pedestrian education programs for school bus passengers grades K-6 Warning letters sent to problem drivers

inspection Random motor vehicle inspection Compulsoxy annual motor vehicle inspection Periodic motor vehicle inspection Periodic motor vehicle inspection Periodic inspection of motor vehicle sample focusing on critical components Periodic motor vehicle inspection

Injury reduction interventions, miscellaneous 192 Terminate sale of three-wheeled All-Terrain Vehicles 175 Require front and rear lights to be on when motorcycle is in motion 175 Selective traffic enforcement programs at high-risk times and locations 217 Insulate omnidirectional CB antennae to avert electrocution 3 1 1 Oxygen depletion sensor systems for gas space heaters 863 Require. employers to ensure employees’ motor vehicle safety 372 “American” oxygen depletion sensor system for gas space heaters

1160 Workplace practice standard for electric power generation operation 175 Pedestrian and bicycle visibility enhancement programs 315 Lock out or tag out of machinery in repair 372 “French” oxygen depletion sensor system for gas space heaters

1005 Redesign chain saws to reduce rotational kickback injuries 101 Ground fault circuit interrupters 468 Ejection system for the Air Force B-58 bomber

1161 Equipment, work practices, and training standard for hazardous waste cleanup

$30,000 $59,000 $89,000

$5l0,000

5 $0 $310 $500 $710

$5,700 $8,700

$20,000 $2 1 ,000 $23,000 $84,000

$180,000 $280,000 $720,000

$ 1,500 $20,000 $2 1,000 $57,000

$390,000 $1,300,000

5 $0 $1,100 $5,200 $8,500

$13,000 $25,000 $51,000 $59,000 $73,000 $99,000

$130,000 $230,000

$1,100,000 $1,200,000 $2,000,000

Toxin control

Arsenic 497

1216 491

1183 1216 497 881

1216 1183 88 1 88 1

control Arsenic emission standard (vs. capture and control) at high-emit copper smelters Arsenic emission control at high-emitting copper smelters Arsenic emission standard (vs. capture and control) at glass plants Arsenic emission control at lowemitting ASARCOEI Paso copper smelter Arsenic emission control at glass plants Arsenic emission standard (vs. capture and control) at lowemit copper smelters Arsenic emission control at secondary lead plants Arsenic emission control at lowemitting copper smelters Arsenic emission control at lowemitting copper smelters Arsenic emission control at primary copper smelters Arsenic emission control at glass manufacturing plants

$36,000 $74,000

$2,300,000 $2,600,000 $2,900,000 $3,900,000 $7,600,000

$16,000,000 $29,000,000 $30,000,000 $5l,OOO,OOO

376

APPENDIX A. Continued.

Tengs et a!

Ref no." Life-saving interventionb

1183 Arsenic emission control at low-emitting Copper Range/white Pine copper smelter

Asbestos control 881 Ban asbestos in brake blocks 819 Asbestos exposure standard of 1.0 (vs. 2.0) fibedcc in asbestos cement industry 881 Ban asbestos in pipeline wrap 881 Ban asbestos in specialw paper 651 Ban products containing asbestos (vs. 0.2 fibedcc standard) 651 Phase in ban of products containing asbestos (vs. 0.2 fibedcc standard) 819 Asbestos exposure standard of 1.0 (vs. 2.0) fibedcc in textile industry 387 Asbestos exposure standard of 0.2 (vs. 2.0) fibers/cc in ship repair industry 881 Ban asbestos in roofing felt 881 Ban asbestos in friction materials 881 Ban asbestos in non-roofing coatings 881 Ban asbestos in millboard 819 Asbestos exposure standard of 0.2 (vs. 0.5) fibedcc in friction products industry 819 Asbestos exposure standard of 0.2 (vs. 0.5) fibedcc in cement industry 881 Ban asbestos in beater-add gaskets 881 Ban asbestos in clutch facings 881 Ban asbestos in roof coatings 881 Ban asbestos in sheet gaskets 881 Ban asbestos in packing 819 Ban products containing asbestos (vs. 0.5 fibedcc) in textile industry 881 Ban asbestos in reinforced plastics 881 Ban asbestos in high grade electrical paper 387 Asbestos exposure standard of 0.2 (vs. 2.0) f i W c c in construction industry 881 Ban asbestos in thread, yarn, etc. 819 Asbestos exposure standard of 1.0 (vs. 2.0) fibedcc in friction products industry 881 Ban asbestos in sealant tape 881 Ban asbestos in automatic transmission components 881 Ban asbestos in acetylene cylinders 881 Ban asbestos in missile liner 881 Ban asbestos in diaphragms

Benzene control 1139 Benzme exposure standard of 1 (vs. 10) ppm in rubber and tire industry 881 Control of new benzene fbgative emissions 881 Control of existing benzene fugative emissions 721 Benzene exposure standard of 1 (vs. 10) ppm 881 Benzene emission control at pharmaceutical manufacturing plants 881 Benzene emission control at coke by-product recovery plants

1139 Benzene exposure standard of 1 (vs. 10) ppm in coke and coal chemicals industry 881 Benzene emission control during transfer operations 881 Control of benzene storage vessels 88 1 Benzene emission control at ethylbenzene/styrene process vents 881 Benzene emission control during waste operations 881 Benzene emission control at maleic anhydride plants 881 Benzene emission control at service stations storage vessels 881 Control of benzene equipment leaks 881 Benzene emission control at chemical manufacturing process vents 881 Benzene emission control at bulk gasoline plants 881 Benzene emission control at chemical manufacturing process vents 881 Benzene emission control at rubber …