In an economic context marked by increasing energy costs and stricter legislation regarding the landfill disposal of wastewater treatment plant (WWTP) sewage sludge, and where biomethanization is difficult to implement in small WWTPs, an efficient alternative is required to manage this polluting waste. This study shows that autothermal thermophilic aerobic digestion (ATAD) is a feasible technique for treating sewage sludge in small- and medium-sized towns. The experiments were carried out at pilot scale on a cyclical basis and in continuous mode for nine months. The main results showed an optimal hydraulic retention time of 7 days, which led to an organic matter removal of 34%. The sanitized sludge meets the microbial quality standards for agronomic application set out in the proposed European sewage sludge directive. An economic assessment for the operation of ATAD technology was carried out, showing a treatment cost of €6.5/ton for dewatered sludge.