I'm working on an indie game and I get surprisingly decent results if I ask for a basic object (think 300 mutations of a key or book) and downsample it to the 48x48 sprite sheet size. They look weird as hell at normal resolution but as pixel art with specific resize sampling methods it's a lot less weird, and good for rapid prototyping.
The originals look like malformed mutants at 256x256 with nonsensical key bits and strange twisted handles.
Note that this does not replace a good pixel art artist either - for things like walls, anything that needs to connect together or tile like a dungeon wall or castle, or a cohesive art style, this will not do. But for rapidly identifiable different quest item drops it's not terrible.
