Yes they work but are more efficient the closer they are mounted to the trailer. I had a wind deflector mounted at the rear of my Leer Shell just a couple of feet forward of my 22' TT and saw a consistent 1.5 to 2.0 improvement in mileage, averaged 12.5 over a two years of towing all over the mountains of AZ, UT, and NM). These numbers were verified by the Scan Gauge and my calculator at the pump on every fill up. At just under $400 it took one year/6,000 miles of towing to break even (figuring $3.50 per gallon). The second year I saved about $400. Check out IconDirect.com
If you tow enough and can mount them at the ideal location they are worth the investment. If they don't work why does every 18 wheeler on the road have a one or a molded cab top that does the same thing? As to its impact on handling I could discern little to no difference but I have never towed a fiver.
For the record a Scan Gauge can save you 8 to 10% on fuel if you just pay attention to the mileage displays and let it educate your right foot.... Just one of the many good reasons to get one, but I digress. :C