Integrated real-time control (RTC) of urban wastewater systems is increasingly presented as a promising and emerging strategy to deliver improved surface water quality by responsive operation according to real-time data collected from the sewer system, treatment plant, and the receiving water. However, the detailed benefits and costs associated with integrated RTC have yet to be comprehensively evaluated. Built on state-of-the-art modeling and analytical tools, a three-step framework is proposed to develop integrated RTC strategies which cost-effectively maximize environmental outcomes. Results from a case study show integrated RTC can improve river quality by over 20% to meet the "good status" requirements of the EU Water Framework Directive with a 15% reduced cost, due to responsive aeration with changing environmental assimilation capacity. The cost-effectiveness of integrated RTC strategies is further demonstrated against tightening environmental standards (to the strictest levels) and against two commonly used compliance strategies. Compared to current practices (seasonal/monthly based operation), integrated RTC strategies can reduce costs while improving resilience of the system to disturbances and reducing environmental risk.