The best place to ask a question like this is on the site for the particular vehicle you have. Tuners do help, but it all depends on what you are wanting it for. I run a hypertek economiser, its a 1 tune that is added and thats it. It does seem to help on my diesel ford. I added a mikes/sct tune to my rv and it definitely helps. I am not looking for milage increases although both seem to have given one. The diesel is much more responsive with and without towing milage went up maybe 1 mpg but overall performance is so much better. We run 80mph non tow and around 19 mpg (2350 rpm), for the rv I got 9+ at 70 crossing nebraska this summer. got 8+ in colorado mountains. so yes it did help and it improved the manners of the v10 significantly.
So go to your site of choice, explain what you have, what you want and then ask them to give you the pros-cons of a particular tuner. BD and some of the others have some downsides, most are recommending other brands with live tune. Just remember many are against tuners, improved air intake systems etc, yet trailer life and motorhome magazines have positive reviews on these installs.