I have Rickson 19. 5's. First with the Bridgestone 724F 245/70R/19. 5's and got 80,000 miles out of the tires. No change in highway mileage except to note it dropped my RPM's by 200 at 70 MPH. There may be some saving of fuel costs, I just have not noticed; 20 MPG highway for an 8,000 pound truck is good by any standard.
Just put on the Michelin XDE-MS 225/70R/19. 5's and I prefer tham over the Bridgestone's. The combination of the 225's vs the 245's and the Michelin tire have given much improved handling on wet roads.
If your intent is to drive the mighty Cummins "til the wheels come off" the 19. 5's are without a doubt cost effective and they greatly increase the drivability of the truck. There is no doubt the up front cost is significant, but simple math demonstrates the cost effectiveness. I was replacing the stock 16" tires every 25,000 miles. The much longer wearing 19. 5's paid for themselves.
Spare tire? I don't need no stinkin' spare. I just went 80,000 miles without a flat. Six 1. 5" roofing nails had no effect.