Co-gasification of solid waste and coal is a very attractive and efficient way of generating power, but also an alternative way, apart from conventional technologies such as incineration and landfill, of treating waste materials. The technology of co-gasification can result in very clean power plants using a wide range of solid fuels but there are considerable economic and environmental challenges. The aim of this study is to present the available existing co-gasification techniques and projects for coal and solid wastes and to investigate the techno-economic feasibility, concerning the installation and operation of a 30MW(e) co-gasification power plant based on integrated gasification combined cycle (IGCC) technology, using lignite and refuse derived fuel (RDF), in the region of Western Macedonia prefecture (WMP), Greece. The gasification block was based on the British Gas-Lurgi (BGL) gasifier, while the gas clean-up block was based on cold gas purification. The competitive advantages of co-gasification systems can be defined both by the fuel feedstock and production flexibility but also by their environmentally sound operation. It also offers the benefit of commercial application of the process by-products, gasification slag and elemental sulphur. Co-gasification of coal and waste can be performed through parallel or direct gasification. Direct gasification constitutes a viable choice for installations with capacities of more than 350MW(e). Parallel gasification, without extensive treatment of produced gas, is recommended for gasifiers of small to medium size installed in regions where coal-fired power plants operate. The preliminary cost estimation indicated that the establishment of an IGCC RDF/lignite plant in the region of WMP is not profitable, due to high specific capital investment and in spite of the lower fuel supply cost. The technology of co-gasification is not mature enough and therefore high capital requirements are needed in order to set up a direct co-gasification plant. The cost of electricity estimated was not competitive, compared to the prices dominating the Greek electricity market and thus further economic evaluation is required. The project would be acceptable if modular construction of the unit was first adopted near operating power plants, based on parallel co-gasification, and gradually incorporating the remaining process steps (gas purification, power generation) with the aim of eventually establishing a true direct co-gasification plant.