Long-term Savings Research Articles

Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. After completion of triage, the psychiatrist returned the practitioner's call ≤5min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

A computationally efficient heuristic approach for solving a new sophisticated arrangement of cogeneration combined heat and power cycle

Cogeneration combined heat and power cycle components are continually optimized using new methods and solutions. Due to the interconnection of two different power generation cycles, the design of the cogeneration cycle is extremely complex and any changes in the structure directly affect the power, efficiency, costs, and other variables. To address this issue, a new arrangement of the cogeneration combined heat and power cycle is presented in this study, as well as a suitable fit function for exergy analysis and evolutionary algorithms used for model optimization. Several objectives are considered when optimizing, such as reducing costs, increasing profitability, etc. Optimization algorithms increased energy efficiency by 2.7% and exergy efficiency by 8.6%, indicating substantial long-term energy savings. A significant improvement was made in all desired parameters as well. Therefore, we can conclude that the upgraded algorithm considered in this study is effective in designing power generation cycles due to the particular importance of optimal design in power generation cycles.

Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity

BackgroundChronic spasticity causes significant impairment and financial burden. Oral baclofen, the first-line therapy, can have intolerable, dose-dependent side effects. Targeted drug delivery (TDD) through intrathecal baclofen delivers smaller amounts of baclofen into the thecal sac via an implanted infusion system. However, the health care resource utilization of patients with spasticity receiving TDD has not been studied extensively. Materials and MethodsAdult patients who received TDD for spasticity between 2009 and 2017 were identified using the IBM MarketScan® data bases. Patients’ use of oral baclofen and health care costs were examined at baseline (one year before implantation) and three years after implantation. A multivariable regression model using the generalized estimating equations method and a log link function was used to compare postimplantation costs with those at baseline. ResultsThe study identified 771 patients with TDD for medication analysis and 576 for cost analysis. At baseline, the median costs were $39,326 (interquartile range [IQR]: $19,526–$80,679), which increased to $75,728 (IQR: $44,199–$122,676) in year 1, decreased to $27,160 (IQR: $11,896–$62,427) in year 2, and increased slightly to $28,008 (IQR: $11,771–$61,885) in year 3. In multivariable analysis, the cost was 47% higher than at baseline (cost ratio [CR] 1.47, 95% CI: 1.32–1.63) in year 1 but was 25% lower (CR 0.75, 95% CI: 0.66–0.86) in year 2 and 32% lower (CR 0.68, 95% CI: 0.59–0.79) in year 3. Before implant, 58% of patients took oral baclofen, which decreased to 24% by year 3. The median daily baclofen dose decreased from 61.8 mg (IQR: 40–86.4) before TDD to 32.8 mg (IQR: 30–65.7) three years later. ConclusionsOur findings indicate that patients who undergo TDD use less oral baclofen, potentially reducing the risk of side effects. Although total health care costs increased immediately after TDD, most likely owing to device and implantation costs, they decreased below baseline after one year. The costs of TDD reach cost neutrality approximately three years after implant, indicating its potential for long-term cost savings.

A two-stage stochastic model for intermodal terminal location and freight distribution under facility disruptions

ABSTRACT A two-stage stochastic model is developed for intermodal facility location and freight distribution under random disruptions at shipper facilities and/or intermodal terminals (IMTs). The magnitude of the disruption and the impacted locations are uncertain parameters. A two-stage stochastic programming model is used to address supply uncertainty at shippers and throughput capacity uncertainty at IMTs. A level-method based decomposition approach and the L-shaped method are used to solve the model. The state of South Carolina in the U.S.A. is used as a case study with the goal of determining the set of IMT locations that minimise the total long-run network costs due to hurricane disruptions. A methodology is developed to generate realistic scenarios. The Freight Analysis Framework Version 4.5 data set is used to generate demands and supply, and k-means clustering is used with the Hurricane database (HURDAT2) to generate hurricane disruption scenarios. Sensitivity analyses are performed by varying the disruption probabilities, disruption duration, and direct shipping cost parameters. The results indicate that as disruptions increase, less disrupted intermodal facilities are opened. Also, as direct shipping costs increase, the long-term savings increase non-linearly for all magnitudes of disruptions.

An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the United Kingdom

ObjectivesPatients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other routes, patients presenting as an emergency have more advanced disease, increased complications, and poorer prognosis. MethodsAn economic model was developed using a decision-tree framework and lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors’ clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included. ResultsThe average per-patient cost of treating myeloma (across all routes) was estimated at £146 261. The average per-patient cost associated with EP (£152 677) was the highest; differences were minimal compared with GP 2-week wait (£149 631) and consultant to consultant (£147 237). GP urgent (£140 025) and GP routine (£130 212) were associated with marginally lower costs. Complication (£42 252) and end-of-life care (£11 273) costs were numerically higher for EP than other routes (£25 021-£38 170 and £9772-£10 458, respectively). ConclusionsAn economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation.

Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands.

In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation. We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4>350cells/μL), late presentation (CD4 200-350cells/μL or >350cells/μL with AIDS-defining illness) and very late presentation (CD4<200cells/μL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests). From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation. Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings.

SG-APSIC1129: Long-term effect of a bundled care program in reducing central-line–associated bloodstream infections

Objectives: Central-line–associated bloodstream infection (CLABSI) has been the leading cause of healthcare-associated infections (HAIs) in the intensive care unit (ICU) setting. Previous studies have shown that a care bundle is effective in reducing CLABSI rates; however, the data on long-term sustainability and cost savings of bundled care are limited. Methods: From January 2011 to December 2020, a prospective surveillance was performed to monitor CLABSI at a university hospital in northern Taiwan. To reduce the CLABSI rate, a hospital-wide bundled care program for CLABSI prevention was implemented in 2013. We evaluated the long-term effect of the care bundle on CLABSI incidence and length of stay in the ICU. Results: During the study period, the overall CLABSI incidence decreased from 8.22 per 1,000 catheter days before the care bundle was implemented to 6.33 per 1,000 catheter days in 2020 (P for trend &lt;.01). The most common pathogens causing CLABSI were gut organisms (1,420 of 2,363, 60.1%), followed by environmental organisms (734 of 2,363, 31.1%) and skin organisms (177 of 2,363, 7.5%). The decreasing trend was statistically significant in the incidence of CLABSI caused by skin organisms (P for trend &lt; .01), but not in the incidence of CLABSI caused by environmental organisms (P for trend = .86) or gut organisms (P for trend = .06). In the multivariable analysis, implementation of this care bundle was independently associated with a decrease in the CLABSI rate (RR, 0.77; 95% CI, 0.66–0.88). Compared with patients without CLABSI, patients with CLABSI had a longer average ICU length of stay (27 vs 17 days). Conclusions: A sustainable reduction in the incidence of CLABSI caused by common commensals could be achieved through a cost-saving bundled care program.

Clinical and Cost Benefits of Anti-Obesity Medication for US Veterans Participating in the MOVE! Weight Management Program.

Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.

Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis.

To examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis. We analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5. A total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits. Access to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings.

Cost and Benefit Analysis of Solar Panels at Home

Due to the high utility costs in Cabanatuan City, the solar panel system is rapidly approaching. People in the middle and lower income classes of the country particularly feel the effects of inflation. In order to address the ongoing rise in oil prices and pollution, the government has made the development of renewable energy one of its top priorities. In order to help consumers reduce their utility costs, save money, and produce greener energy, a study on the installation of a solar panel system at home was carried out. The researchers gathered some data from consumers to be utilized as the basis for the contractors' computations, where the adoption of a 3kw on-grid solar panel system was recommended to those respondents with power bills under ₱2,400. The project costs approximately ₱150,000 in total, including installation and permits, and can save approximately ₱2,300 monthly. This investment has a 5.4-year payback period and a total savings of ₱402,000 over a 20-year period. The consumption analysis revealed a sensitive effect on savings and investment payback periods. The study proved that the project's long-term savings can be more than double the initial investment. A SWOT analysis was also performed to highlight the advantages and disadvantages of having an on-grid solar panel, as well as the benefits of clean energy and gas reduction in our environment that future generations could benefit from. The project's cost-benefit is a win-win investment for everyone who wants to save money while also enjoying cleaner air in the long run.

Long Term Energy Savings Through User Behavior Modeling in Smart Homes

The Internet of Things (IoT) has enabled real-time monitoring of energy consumption in smart homes through sensors embedded in the surrounding environment. In the post-pandemic world, domestic energy management has gained importance due to increased work-from-home consumption, making data collection in a smart home a relevant IoT application with many potential energy savings. However, this information is difficult for most users to understand, and existing monitoring systems’ savings results degrade over time. To address these challenges, this study presents a novel approach for domestic energy consumption, production, and comfort perception using color-based dashboards enhanced for user feedback interaction. The approach includes the management of in-home appliances and comfort levels according to user preferences to attain long-term energy savings. The approach includes multiple appealing strategies such as 3D representation, mobile connectivity, utility integration, and dynamic information, to increase long-term engagement and provides quantitative data on energy savings achieved for one year, where the average energy consumption was reduced by 19%. It was found that the approach sustained user engagement over time, with users actively participating in energy conservation efforts. A community survey with 208 participants was also developed and studied where 69% of the enquired considered our approach more attractive than existing market solutions, and 79% considered it more useful than existing solutions. Regarding the real-time information presented on our approach, 81% of the participants strongly or totally agree that it can change users’ behaviors.

Component Reusability for Long-term Emission Savings

Component Reusability for Long-term Emission Savings

Comparative preference of loans provided by SBI and ICICI with reference to Coimbatore district

The need for home loans arises not because property prices are heading upwards all the time but because home loans make great sense from a long-term savings perspective. The study is about comparison of service of SBI and ICICI. The main objective of the study is that to know about the socio-economic profile of the respondents availing home loan in SBI and ICICI Bank in Coimbatore city and to study on the customer opinion about services and the problems faced by them. The study was analyzed with descriptive research with 125 samples from ICICI and 125 samples from SBI were percentage analysis, chi square, descriptive statistics and factor analysis were used as tools for analyzing the data. The conclusion is that the service provided by ICICI is better than SBI based on the interest rate and both the banks have to implement new technology to reduce the process time of loans which leads to satisfaction of customers in future period of time.

The equitable housing workshop. Mapping and improving stakeholders’ decision-making process for circular equitable housing projects.

A growing housing crisis in Western Europe increases the pressure on conventional support measures and further reduces the accessibility to equitable housing. Yet, the necessary transition to a sustainable and circular construction economy could be an opportunity to meet this social challenge. Research on the long-term costs and savings of circular strategies in housing projects demonstrates that applying specific circular strategies to specific projects can improve the long-term affordability of housing. Little research mentions circular building’s relation to housing quality nor the decision mechanism behind the design process of housing projects. Since these decisions are not only based on costs, but also social factors and practical considerations, it is important to take these into account. Introducing systems thinking in the design process could lead to more inclusive, and mindful decision making in the design process of housing projects. This paper proposes a methodology to encourage stakeholders in a housing project to think systemically and to have an open discussion about housing dimensions. The equitable housing workshop allows us to visually display rather complex networks of decisions and influences present in a project. The workshop continues by challenging the participants to find solutions that fit within the equitable housing model. These solutions are then linked to circular building strategies to encourage participants to look for sustainable and circular solutions. This also shows them how circular building design can make housing more equitable, and therefore, give them the tools to tailor a circular strategy specifically to their project. For researchers, analysing the participant’s discussions, held throughout the workshop, can bring new insights into the relationship between equitable housing and circular building.

An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs

To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States. Observational retrospective cohort study with propensity score matching of treated and control groups. Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months. The study included 1800 adults with substance use disorder (SUD), anxiety, or depression who were eligible for the intervention. Treated members (n = 900) graduated from the program. Matched control members (n = 900) were eligible but never enrolled. Primary outcomes included all-cause and disease-attributable health care cost and utilization PMPM, categorized by place of service. There were statistically significant reductions in total all-cause medical costs of $485 PMPM (P < .001) and a 66% pre-post reduction in inpatient encounters, with $488 PMPM DID savings for inpatient admissions (P < .001) among the treated cohort compared with the control cohort over 36 months. Conversely, there were statistically significant cost increases ($110 PMPM; P < .001) for all-cause office visits in the treated cohort compared with the control cohort. Similar results were seen in SUD-attributable and BH-attributablecosts. Although the results could be affected by unmeasured confounding, they suggest that care coaching interventions that offer BH provider referrals may produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat BH conditions. Rigorous evaluations are needed to confirm these findings.

Simulation of Pathways toward Low-Carbon Electricity Generation in the Arctic

This paper examines the various pathways toward energy transition available to remote Arctic communities. Inhabitants of Arctic communities often face significant cost burdens due to high energy prices. Electricity costs are particularly high, due in part to the predominant use of diesel for electricity generation in over 80% of remote Arctic communities. This study examines the different approaches for integrating renewable energy sources, with a focus on the different strategies that might be implemented to finance the energy transition toward greater use of such renewable sources. The high costs associated with project realization in the remote Arctic present special challenges. This study uses a system dynamics model to evaluate the various financing tools available to facilitate the energy transition. The model results indicate that the integration of renewable energy sources has the potential to yield long-term electricity cost savings for the remote Arctic communities in question.

Improvement in glycaemic control in patients with type 2 diabetes with treatment using an interactive mobile application – A pilot study from India

AimsWe studied the outcome of glycaemic management using Diahome, a smart-phone application compared to conventional treatment. Overall acceptability of the application among users was also assessed. MethodsThis is a retrospective, case-control study of patients on virtual diabetes care using the Diahome app (n = 441) and those visited the hospital out-patient services (n = 446) between April and June 2021. Men and women aged 45–60 years with type 2 diabetes (T2DM) were selected. ResultsA total of 173 records with initial and follow-up visits were analyzed (app users n = 91, non-app users n = 82). Participants were aged 59 ± 12 years and were obese. The two groups were similar by age, gender distribution and duration of T2DM. Fasting blood glucose significantly reduced only among the app-users from a baseline level of 156 ± 70 mg/dl to 129 ± 40 mg/dl at follow-up (p < 0.02). Reduction in HbA1c levels was observed in both groups (p < 0.0001); percentage improvement was better among app (15.8%) than in non-app users (10.4%), p = 0.004. Triglycerides level were higher at both time points among app-users (p < 0.05) as compared to the other group. More than 56% of the users rated the performance of Diahome app as excellent; virtual consultation was rated the highest (71.5%) among the Diahome services. DiscussionGlycaemic management of diabetes using a dedicated mobile application was superior to in-person hospital visits. Its long-term effectiveness and cost savings need to be ascertained.

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures.

A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective. The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses. The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%. Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available. Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.

Contractual Behavior of Key Participant in Managing Green Office Building Projects

In order to improve the performance of green office building projects, proper contractual behaviour of key participants is perceived as one of the best initiatives, given that it serves as the primary function in guiding the smooth management of green office building projects. This paper aims to identify the criteria in managing green office building projects. It was found that this reports on the results of the content analysis which collected data on design and features of green office building implemented by the designers. A list of GBI -Certified Green Office Buildings under New Construction Category in Malaysia was assessed. Five (5) numbers of office buildings in Klang Valley and Putrajaya area were selected to present features of green office buildings applied by the designer to fulfil the green building criteria hence achieving GBI certification. The features of each green building obtained from various relevant websites were compiled based on the six (6) criteria listed under GBI. Though the system and materials might be slightly different from one green buildings to another, there are similarities in terms design principal; by incorporating advanced green technologies, sustainable energy solutions, innovative energy management systems and rainwater harvesting systems into the design. Thorough consideration has been given by the project team to produce a building that is environmentally, socially and economically friendly. This is achieved by enhancing good passive designs and integrating active (mechanical and electrical) design and system to deliver and to offer significant long-term comfort and savings for the building owners and occupants.

Quantifying the impact of delivery day flexibility on last-mile delivery costs

Last-mile delivery operations are often required to uphold rigid delivery dates, such as the day after an order is placed. However, given the inherent temporal stochasticity in customer order placement, this practice can overwhelm the available vehicle fleet with long routes and the need for driver overtime. This work explores the potential benefits of customer flexibility, wherein the delivery day can be chosen by the distributor from among pre-agreed delivery day windows spanning two or more consecutive days, allowing the delivery day to be co-optimized along the associated vehicle routes and leading to distribution cost savings. To that end, we develop a rolling horizon simulation framework that integrates a novel forecasting scheme for sampling order realizations with a branch-and-cut algorithm for solving the multi-period vehicle routing instances arising on each day. Computational studies using real-life industrial data are conducted to compare various decision policies and quantify the long-term cost savings that are possible when allowing such flexibility. In certain cases, we reveal the potential of significant cost savings–up to 12%–compared to the current “next-day” delivery policy. Our study also investigates the extent of discount incentives that may be offered to customers for accepting flexible delivery days.