High altitude would be good for fuel economy except for one thing: uphill grades.
Most high altitude terrain I've ever seen is either uphill or downhill, rarely flat.
Remember you road load equation: 20 lb load per ton per percent grade. Entropy assures you never recover all your potential energy coming downhill.
BTW, a 6.2 GM diesel (mine) made it to Leadville and over every pass I tried. I even got the thing to the summit of Pike's Peak - Altitude 14,406 ft.
Caveat: I did have to slow down and it smoked like a steam locomotive.
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2000 Ford F-350 SC 4x2 6 Speed Manual
4" Slam
3.08:1 gears and Gear Vendor Overdrive
Rubber Conveyor Belt Air Dam
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