Improving the efficiency of waste-to-energy combined heat and power plants increases their production of both electricity and heat. Economic evaluation of such improvements enables adequate decisions to be made between the various alternatives with respect to economic viability of the plant. In this study, the cost and profitability of different modifications to improve efficiency in a waste-to-energy plant are considered: these include the re-arrangement of air heaters, the introduction of a reheater, flue gas condensation (FGC) and an integrated gasification-combustion process. The base case and the modifications are evaluated and compared when operating either as a combined heat and power plant or as a power plant. Modelling, simulation and cost estimations were performed with the Aspen Plus software. Although the integrated gasification-combustion technology with FGC has the highest exergy efficiency, its higher capital cost is greater than all of the other alternatives. Modification 6, which involves both re-arrangement and changing the air heating medium has the lowest capital cost with respect to enhancing exergy efficiency. Modifications 1 and 7, involving FGC, are the best alternatives for the capital cost per total unit of revenue generated. These modifications not only provides the highest heat production but also the highest net present value (NPV). The base case and the modifications investigated all have positive NPV, indicating that a waste-to-energy combined heat and power plant is an attractive investment. However, an increase of about 122% in the gate fees would be required for a system with only electricity production to be profitable.