Here are my thoughts on the advantages and disadvantages of each. Please let me know what you think.
The disadvantage to gears to me would be highway RPM and fuel mileage on the highway. My tires are only 31.5" (285/50r20) and with 4.56s on the highway, I would be turning about 2500 at 70mph. With my 3.92s I am just under 2000 rpm and I get over 18 mpg.
In the city I see no disadvantage to the gears.
Cam, disadvantage is dealing with custom tuning (not that big of a deal), and mainly finding someone to install it. But I would get increased performance and keep my fuel mileage on the highway.
Get the gears first....
My truck has 31.25" tall tires and at 70mph I'm squeeking by 2300rpms which for highway driving is where you WANT to be, thats where the best mpgs are at. There is no way you will be hitting 2500rpms at 70mph. Also I have been getting about 2mpg better all around after they were installed (30/70 City/HWY) so MPG's with the gears are not bad at all... DONT FEAR THE GEAR!!
Second, you will probably loose mpgs with the cam just because ofthe extra performance gains, tuning, adjusting the fuel trims to get you that perfect AFR etc. Not much but I would bet it either breaks even or drops a little.
Cost between the two will be about the same assuming that you dont take it to a shop to install the cam.
Third - WHY IS MPG EVEN AN ISSUE HERE????? Its a truck, a big heavy truck and you want to make it go FAST... Never quite understood why mpg is an issue when it comes down to making heavy trucks go faster.... But if you are that concerned about it neither of the two mods is going to drop you that much in mpg if they do at all as long as you dont get on it much, which is very hard to do.