Cereal leaf beetle, Oulema melanopus L., can be effectively managed in southeastern U.S. wheat, Triticum aestivum L., with scouting and a single insecticide treatment, applied at the recommended economic threshold. However, many growers eschew this approach for a prophylactic treatment, often tank mixed with a nitrogen application before wheat growth stage 30. The efficacy of a prophylactic and an integrated pest management (IPM) approach was compared for 2 yr using small plot studies in North Carolina and regional surveys across North Carolina and Virginia. Economic analyses were performed, comparing the total cost of management of each approach using the regional survey data. From a cost perspective, the prophylactic approach was riskier, because when cereal leaf beetle densities were high, economic loss was also high. However, fields under the prophylactic approach did not exceed threshold as often as fields using IPM. Total cost of prophylactic management was also $20.72 less per hectare, giving this approach an economic advantage over IPM. The majority of fields under the IPM approach did not exceed the economic threshold. Hence, from an economic perspective, both the prophylactic and IPM approaches have advantages and disadvantages. This helps explains the partial, rather than complete, adoption of IPM by southeastern U.S. wheat growers. Cereal leaf beetle was spatially aggregated across the region in 2010, but not in 2011. As a result, from an economic standpoint, prophylaxis or IPM may have a better fit in localized areas of the region than others. Finally, because IPM adoption is favored when it has a strong economic advantage over alternative management approaches, more emphasis should be placed on research to reduce costs within the IPM approach.