Sewage sludge is a by-product of wastewater treatment that simultaneously gathers contaminants, valuable organic matter, and nutrients. The treatment of the increasing amount of sewage sludge is important from both pollution prevention and resource recovery perspectives as i) large shares of mineral phosphorus, listed as a critical raw material, terminate in the sewage sludge, and ii) energy recovery from sewage sludge can cover the energy-intensive demand of the treatment process. Previous research has identified sewage sludge combustion as a suitable treatment approach as it both addresses contaminant destruction and paves the way for efficient phosphorus recovery from the sewage sludge ash. The commercial development of this practice has, however, been slow. Therefore, this thesis aims to investigate the challenges in sustainable sewage sludge management, and to, in more detail, identify the economic viability of energy and phosphorus recovery from sewage sludge through combustion. The thesis’ aim is divided into two objectives addressed in three papers. First, to investigate how different aspects of sewage sludge management, such as contaminants, economic efficiency, technical aspects, and legislation, evolve and interact. This has been done by a review of sewage sludge management research over fifty years (Paper I). Second, to investigate the economic viability of simultaneous energy and phosphorus recovery from sewage sludge by comparing different technology and market scenarios. This has been done for i) new sewage sludge mono-/co-combustion plants (Paper II), and ii) the integration of treatment technologies, mainly anaerobic digestion, hydrothermal carbonization, and combustion, in an existing wastewater treatment plant (Paper III).  Results from the analysis of sewage sludge management research (Paper I) show a narrow-focused perspective that often excludes inseparable aspects such as combination of economic consideration and advanced extraction technology. The investment viability of a new mono-/co-combustion of sewage sludge (Paper II) is highly conditional on heat, electricity, and fertilizer price, and external financial support is often a crucial requirement. Sewage sludge co-combustion with potassium-rich biomasses improves sewage sludge quality and forms usable ash as fertilizer without further need for phosphorus recovery technology. In this case, the economic feasibility of the process is independent of usable ash revenue, which stimulates a competitive selling price for the ash, thereby improving the marketing of sludge-based fertilizer. Avoided disposal costs of sewage sludge for a retrofitted wastewater treatment plant by introducing hydrothermal carbonization (Paper III) shows good economic feasibility while recovering phosphorus. Integrating anaerobic digestion, hydrothermal carbonization, and combustion may also improve investment incentives by improving energy outputs and phosphorus recovery. The economic feasibility is contingent on product (hydrochar, heat, electricity) prices and sensitive to added equipment costs, and costs for sludge transportation and disposal.