OBJECTIVES: Patients requiring a coronary stent can receive a bare-metal stent (BMS) or a drug-eluting stent (DES), but both have their advantages and disadvantages. We estimated the potential one-year cost-effectiveness of a test to decide which stent a patient should receive based on the risk of restenosis after a BMS implantation. METHODS: This study was performed as part of a Dutch large-scale five-year study (“Circulating Cells”) now underway to identify blood biomarkers to facilitate the prevention and treatment of coronary heart disease. A Markov chain Monte Carlo model was developed to estimate costs and effectiveness for three strategies: DES for all patients, BMS for all patients, and use of a test (80% sensitivity & 80% specificity). Input values were based on the literature and expert opinion. Costs were calculated according to the healthcare sector perspective. Scenario and sensitivity analyses were performed to test the robustness of the results. RESULTS: The DES-for-all strategy was the most effective (0.840 QALYs), followed by the test strategy (0.839) and the BMS-for-all strategy (0.838). However, it was also more costly (€8189) than the other two (test strategy, €7475; BMS, €6905). These results meant high incremental cost-effectiveness ratios for the test and DES-for-all strategies. Implanting DES in all patients would have an important budget impact (€46,000,000) for the Netherlands, given 36,000 interventions annually. Various input parameters had an important influence on the results, including the sensitivity, specificity and costs of the test. CONCLUSIONS: Both DES and BMS stents are often used for PCIs in the Netherlands. A stratifying test has the potential to reduce costs and still achieve acceptable effects. The impact of adopting a longer time horizon to capture very late stent thrombosis needs to be examined. The model developed in this study will be used to facilitate further development of the biomarker test.