OBJECTIVES: The 2012 European guideline on cardiovascular disease prevention recommends statin therapy for individuals with elevated cholesterol levels and with an intermediate risk of fatal events. However, since many individuals fall into this category, improved discrimination is needed to prevent both cardiovascular disease (CVD) and statin side-effects (e.g. myopathy) efficiently. We estimated the potential cost-effectiveness of a novel biomarker test which helps to decide which individuals with an intermediate risk should receive statins. METHODS: Prognosis of different age- and gender-specific cohorts with an intermediate risk was simulated with a literature-based Markov model to estimate the potential costs and quality-adjusted life-years (QALYs) for four strategies: treat all with statins, treat none with statins, treat according to the European guideline or use a test to select individuals for statin treatment. Costs were calculated for the Netherlands using a healthcare sector perspective. RESULTS: The test-first strategy was the least expensive strategy as long as a perfect test cost no more than €304 at a threshold of €20000 per QALY gained. The perfect test-first and treat-all strategy reduced the same number of events leading to comparable QALYs but the test generated lower medication and drug side-effect costs. The treat-none strategy was the least cost-effective strategy. The test needs to be very accurate and inexpensive in order to be the most cost-effective strategy, since the impact of myopathy on cost-effectiveness is negligible and statin costs are low. CONCLUSIONS: A test that improves treatment decisions for individuals with an intermediate CVD risk has the potential to optimize cost-effectiveness by reducing the risk of drug side-effects and budget impact. However, given the outcomes of this ‘early stage’ cost-effectiveness analysis there may be limited value in developing a test with this indication. Early stage economic evaluations can assist industry in determining whether a test is worth developing.