It's expensive. A relative has one in the northern Great Lakes, they wouldn't have installed it if their house had access to natural gas.

Our house came with one and we upgraded the unit a few years ago. It's very efficient in terms of units of energy consumed, but in my area of the world gas is significantly cheaper than electricity so it ends up being expensive to run.

That said, we will install solar at some point and then it'll be "free" HVAC.