Hotel room service = almost never. In the distant past I tried room service many times while on business and the quality of the food was rarely good. Now I try to identify a popular establishment outside of the hotel before I get there and bring power bars and healthy snacks to skip a meal rather than order room service in remote hotels. I never touch the mini bar. Bad food equals poor sleep and a tiring trip for me. I learned a visit to the fitness room and light meal can keep you energized all the way back home and make those cross country flights more bearable.
I have had no spending restrictions so the extra cost is not a factor - it's just the poor quality food that does more harm than good. (memories of unripe fruit and overcooked pasta)
These days I only get room service for breakfast on special occasions (like a room with a patio on the water in Auckland)