/me looks at his February bill and remembers the lesson all too well
From what I can tell, the only reasons to use alex/letsencrypt-aws (IAM certificates) instead of AWS Certificate Manager are if you're either 1, provisioning ELBs in a region other than us-east-1 and unable to wait for Amazon to roll out ACM to other regions; or 2, subsequently applying the same certificate to other resources in addition to ELB+CloudFront (e.g., a standalone EC2 instance running nginx or apache).
Unfortunately it looks as though letsencrypt-aws won't either.
I've had good results using https://github.com/sorah/acmesmith which also uses the dns-01 challenge via Route53, but saves certificates to an S3 bucket that can be fetched from any EC2 instance granted the proper permissions.
So basically you can get up to 13 months worth of certificates out of one token/solved challenge. That being said, none of the clients I'm aware of currently reuse authorizations - they create a new one during renewal, which would result in a new token.