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If you are trying to make use of it, you'll be unlikely to make good time during your run, and some very good items make it nearly/completely useless.
Overall one of my least favorite devil deal items. I'd probably only buy it if I had extra red health and was already in key/bomb poverty. In practice, I've only gotten it from chaos or when I was using it to remove red health.
Not only it can give you a lot soul hearts which is always good, but also stats up, that at the end of the run actually giving you huge stats boost.
I guess it depends on player skill. For me (most of the time) it's easy and fun to kill enemies in order. Also I always try to get rid off of red hearts, so even without possible profit it's k.
Free items/stats in rooms without enemies (only buttons) is amazing too.
I never noticed. I just thought that sometimes it would randomly not pay out with items.
"Finally googles what it actually does"
OH. That's a horse of a somewhat different color.
The state boosts are pretty rare.
The item has a lot of potential, but that potential is blocked by how the game works itself, so I wouldn't consider it a "good" item.