We haven't upgraded our Smartermail installation in several years since the pricing change as we did not and do not see the value in Smartermail with the increased pricing.  Especially, now that cPanel have implemented a version of Exchange ActiveSync for all email accounts at no additional price premium.

However, one thing that would make Smartermail worth it to us again (assuming another new separate fee wasn't added on top of all of the other fees) would be if Smartermail implemented / offered an encrypted email option in the web interface to allow HIPAA information to be emailed using a PGP key or something similar (click to access link on the remote end with the actual email stored encrypted on the Smartermail server itself).