I use it since they had the engine out of my 2003 for a rebuild and the engine was "Dry" going back in.
I have a zero PSI radiator cap mod (hole drilled in it) so the stress on the heater core and hoses are near zero. As a DD it works well and the zero PSI is a plus in my book having blown heater cores up with the scalding coolant landing on passenger's feet. Evans doesn't vaporize in the engine leaving pockets of steam with no cooling on engine hot spots or causing erosion from the boiling. You would be amazed at the amount of steam coming out of a loaded engine into the radiator requiring cooling below 212 degrees to condense even as an antifreeze mix. EVANS doesn't suffer from this. I will not have to change the EVANS out for the lifetime of the engine.
The disadvantages:
1) Flammability is a concern often brought up although most coolants except pure water will burn. Ethylene glycol has a flash point of 232 deg F so if heated to that temp it becomes flammable in the context of an escaping spray of coolant into an engine fire environment. Consider a Zero PSI Evans system isn't going to spray like the OEM 16 PSI system.
2) Reduced cooling ability. Best example is pure water cools better than a 50/50 mix of antifreeze and water.
3) You can't use a high watt density block heater, aka the one we got in the 5.9, as it can coke the coolant.
More info here.
4) It expands more than water so leave the expansion tank nearly empty.
5) Smell - it has an odor to it especially when new. The odor fades some with time. I can tell the engine blowby and the EVANS smell after shutdown.
6) Availability. Use distilled water in an emergency as you can boil it off to recover your EVANS. I carry an extra gallon of it.
7) It's hygroscopic like brake fluid so keep the system and containers closed as much as possible.
Let me expand on efficiency.
Towing a 27' AF 5th wheel near the GCWR for the truck, aerodynamics of a skyscraper, 100-121 degrees out, and good grades of at least 4-10% that go on for miles...
On the stock 2003 HO tune EVANS is fine. The OEM temp gauge doesn't pass the right edge of the center 200 number.
When I throw the SMARTY tunes at it and push 1250-1300 EGT the ECT starts to climb on grades at the top of 4th gear (3000 RPM ~50 MPH) where I complain about the fan belt possibly slipping. I have seen 237 ECT once before backing off and it's using most of the OEM temp gauge. As it's a zero PSI system the last thing I am worried about is the coolant boiling over: This is an advantage to EVANS. Note I also have a BB coolant cooled turbo center section adding heat to the system now. I do worry about the limits of engine oil as oil failure from getting too hot will scuff a piston. Synthetic oil would buy me more temperature headroom. However I am at the limits of the cooling system with the Smarty Tune, hot AZ weather, and reduced ability of EVANS to move heat with the stock water pump and T-Stat. Again the Stock HO tune is fine with EVANS foot to the floor at the top of 4th gear. How much EVANS efficiency affects the system I can't be exact on as clearly I am pushing the limits so regular coolant may not buy me anything.
A high flow T-Stat and higher flow water pump would be a plus, but, I don't know of anyone who makes them for the 5.9 Cummins.