It would be helpful to get more information about how frailty affects the financial burden of recovery from surgery to repair adult cervical deformity (CD). The study’s objective was to determine how preexisting fragility affects the cost of CD surgery. The method used was a retrospective cohort study. Patients with CD with baseline and 2-year data on the Neck Disability Index and frailty scores were considered. Patients were classified as not frail (NF) or fragile (F) based on their frailty score using the modified CD frailty index. After controlling for age, sex, surgical method, and baseline values for sacral slope, T1 slope minus cervical lordosis, C2-C7 angle, and C2-C7 sagittal vertical axis, marginal means were estimated using analysis of covariance. The price tags came from the register data of PearlDiver. Medicare services provided during a 30-day period, such as hospitalization, hospice care, and end-of-life care, were reimbursed using a standard estimate derived from a regression study of Medicare pay scales. This information is representative of the typical Medicare expenditure across the country, broken down by the presence or absence of complications and co-morbidities, surgical strategy, and the need for revisions. Patients with NF and F had their costs divided by the number of years they lived, resulting in a cost per quality-adjusted life-year (QALY) at 2 years. Around 126 individuals were included in the analysis. The total number of NF patients was 68, while the number of F patients was 58. Overall morbidity, the occurrence of distal junctional kyphosis, and the need for additional surgeries were not different between the frailty groups (all P>0.05). By 2 years, there was no statistically significant difference in the radiographic and clinical improvement rates between the 2 groups. Total expenses for NF and F were comparable ($36,731.03 vs. $37,356.75, P=0.793), and costs per quality-adjusted life year (QALY) after 2  years were also similar ($90,113.79 vs. $80,866.66, P=0.097). Cost per quality-adjusted life-year (QALY) at 2  years was comparable for F and NF patients due to the similarity in complications, initial costs, and utility gained. When considering the expected utility gained and the cost-effectiveness of the surgery, surgical repair for CD is a cost-effective healthcare intervention for patients with F.