Organic carbon can affect the biological nitrogen removal process since the Anammox, heterotrophic and denitrifying bacteria have different affinities and feedback in relation to carbon/nitrogen ratio. Therefore, we reviewed the wastewater carbon concentration, its biodegradability and bioavailability to choose the appropriate nitrogen removal process between conventional (nitrification-denitrification) and Anammox-based process (i.e. integrated with the partial nitritation, nitritation, simultaneous partial nitrification and denitrification or partial-denitrification). This review will cover: (i) strategies to choose the best nitrogen removal route according to the wastewater characteristics in relation to the organic matter bioavailability and biodegradability; (ii) strategies to efficiently remove nitrogen and the remaining carbon from effluent in anammox-based process and its operating cost; (iii) an economic analysis to determine the operational costs of two-units Anammox-based process when compared with the commonly applied one-unit Anammox system (partial-nitritation-Anammox). On this review, a list of alternatives are summarized and explained for different nitrogen and biodegradable organic carbon concentrations, which are the main factors to determine the best treatment process, based on operational and economic terms. In summary, it depends on the wastewater carbon biodegradability, which implies in the wastewater treatment cost. Thus, to apply the conventional nitrification/denitrification process a CODb/N ratio higher than 3.5 is required to achieve full nitrogen removal efficiency. For an economic point of view, according to the analysis the minimum CODb/gN for successful nitrogen removal by nitrification/denitrification is 5.8 g. If ratios lower than 3.5 are applied, for successfully higher nitrogen removal rates and the economic feasibility of the treatment, Anammox-based routes can be applied to the wastewater treatment plant.