OBJECTIVES Implantation of toric intraocular lens (IOL) corrects preexisting astigmatism in cataract patients, providing better clinical outcomes compared to conventional monofocal IOLs. We sought to assess the impact of these clinical outcomes on lifetime patient health-related quality of life (HRQL) and economic outcomes. METHODS A clinically based economic model examined outcomes in cataract patients ≥ 65 years old with pre-existing astigmatism (1.5-3D). Subjects received either bilateral toric IOLs or conventional IOLs, with or without intra-operative refractive correction for astigmatism. Data obtained from a systematic literature review were supplemented with survey results from 60 United States cataract and refractive surgeons. A prospective study provided data translating uncorrected visual acuity (UCVA) to patient utilities. Outcomes were projected over life time and discounted at 3%. RESULTS The proportion of patients achieving spectacle independence and UCVA ≥ 20/25 with toric IOL was greater (67% and 53%) than that with conventional IOL with (63% and 48%) or without (53% and 44%) intra-operative refractive correction. Due to better UCVA outcomes, Toric IOL resulted in better utility scores than conventional IOL with and without intra-operative refractive correction. This utility gain, coupled with a reduced lifetime likelihood of wearing glasses and contact lenses resulted in toric IOL being the dominant strategy over conventional IOL without intra-operative refractive correction. The use of toric IOL resulted in the total lifetime cost saving of $336/QALY. CONCLUSIONS Toric IOLs improve patients' HRQL by providing better vision outcomes and reduction in the need for intra- and post-operative refractive correction in cataract patients with astigmatism thus reducing the risks associated with refractive surgery. Other than visual acuity, additional factors should be considered by physicians and patients for the initial choice of treatment: the inconvenience of travel with glasses, lens cleaning and intangible benefits associated with improved self-perception.