The adjustments are very very easy to do, and they really will help you out when it comes time to tune your bow. I actually wrote down the settings on my arrow rest so if something goes wrong, I can put the rest back to those specs and be in the ball-park.
The launchers do wear away, but, it does take some time. I have the same launchers on as when I got the rest, and that was about a year ago. They have had ALOT of shots and are showing a little wear. My friend has had his QT3000 for about three years and he has only replaces the launchers once.
In all that time, neither of us have had any complaints or problems with the rest. That should say something........ huh Rack

I am shooting straight fletch, so fletch contact is NOT an issue. My friend is using 4 degree right helical and he has no fletch contact either. When we were tuning the bows, we checked that thoroughly and there was none.
I have not had any problems with my arrow comming off the rest. My arrows are 29.25" PSE' s and I am shooting these with a 30" draw length. My friend has had the arrows jump off his rest a few times (27.5" Eastons with 28" draw) but that is more due to the way he draws his bow.
Overall, I would say that this is probablly the easiest prong rest on the market to tune, the quality is what you would expect from N.A.P., and this is a tough rest. Definetly worth the money.