Here we go again.
The entire process for N&P can be automated. That includes backing up files, settings, drivers, installing an image, drivers, restoring data, and even to some degree, programs. 5 Seconds to kick it off, and an hour later, a fresh clean machine with all the files and settings, and some to all of the programs.
Now I'm not saying N&P every time. If anyone has ever dealt with a lawyer, you'll know the worst kind of people to deal with from an IT perspective; anything out of place gets scrutinized. Unless absolutely necessary, you never N&P their system. There are however, plenty of people in which an N&P is going to be a better option, especially if you automate the process.
I'll repeat myself, N&P isn't what you should be looking at first whenever you tackle a malware issue. It's also not something you should look at as a "second rate" repair. When you first look at a system, you should consider the amount of time it's going to take you, the probable return rate, the client's attitude, and how inconvenienced they would be with a N&P over a removal. You can weigh the factors and made an education decision on the best course of action for you and your client.