I only use it for complicated boards where routing a great many nets is a chore (typically digital logic, buses and interfaces). I usually route everything around the area of interest first, and exclude those nets from the autorouter. (Examples: support components, power converters, supply rails, etc.)
Significant cleanup is always necessary, and it feels like 10-20% savings in space and average trace length can be had by inspecting the results and shorting across "dumb" decisions.
Starting with a routed layout, even poorly done, can be valuable. It speeds up subsequent changes or optimization, because you can see at a glance where everything needs to go, and how the existing layout is wrong (electrically, or to your aesthetics) and how to fix it.
Tim