Sewage treatment is an important public service, but it consumes a lot of energy and chemicals in the process of removing wastewater pollutants, which may cause the risk of pollution transfer. To find the corresponding hot issues, this paper took the lead in integrating life cycle assessment (LCA) with life cycle costing (LCC) to evaluate four most typical sewage treatment technologies with more than 85% share in China. It is found that anaerobic/anoxic/oxic (AAO) was the optimal treatment scheme with relatively small potential environmental impact and economic load. The normalized results show that the trends of the four technologies on eleven environmental impact categories were basically the same. Marine aquatic ecotoxicity potential accounted for more than 70% of the overall environmental impact. Contribution analysis indicates that electricity and flocculant consumption were the main processes responsible for the environmental and economic burden. Overall, electricity consumption was the biggest hot spot. Sensitivity analysis verifies that a 10% reduction in electricity could bring high benefits to both the economy and the environment. These findings are expected to provide effective feedback on the operation and improvement of sewage treatment