Five pasta formulations containing 0 (PTWF0), 6 (PTWF6), 12 (PTWF12), 17 (PTWF17), and 23 g/100 g (PTWF23) of tilapia-waste flour (TWF), and a commercial pasta were evaluated concerning physicochemical and sensory characteristics. TWF increased (p < 0.05) protein, lipid and ash levels, energy value, cooking loss (CL), redness, yellowness, chroma (C-star), total color difference (Delta E), hardness, and chewiness, and decreased (p < 0.05) carbohydrate content, optimal cooking time (OCT), water absorption index (WAI), swelling index (SI), lightness, hue angle (H degrees), springiness, cohesiveness, and resilience. Considering PTWF0 and PTWF23, the results ranged between 8.44 and 18.38 g/100 g for protein, 1.88 and 4.94 g/100 g for lipid, 1.88 and 4.08 for redness, 19.24 and 28.45 for yellowness, 3.13 and 4.66 N for hardness, 1.75 and 3.01 N x mm for chewiness. PTWF0, PTWF6, PTWF12, PTWF17 and PTWF23 had 9.00, 9.30, 9.30, 7.30, 7.00 and 6.00 min of OCT, 97.30, 97.10, 96.19, 88.82, 85.41 and 83.02 g/100 g of WAI, 2.49, 2.53, 2.49, 2.23, 2.18 and 2.03 g water/g dry pasta of SI, and 2.43, 2.45, 2.51, 3.17, 3.69 and 4.06 g/100 g of CL, respectively. The addition of 12-23 g/100 g TWF resulted in a negative effect on sensory characteristics, such as color (darkening), texture (crumbly/brittle/grainy dough), aroma and flavor (fishy off-flavor), with consequent decrease in overall consumer acceptance. Despite these findings and considering a consumer rejection probability of 50%, a survival analysis revealed that TWF may be added to pasta at up to 11.10 and 11.34 g/100 g without compromising acceptance and purchase intention (p < 0.05), respectively. Thus, the addition of 6 g/100 g TWF improves product nutritional value without jeopardizing pasta quality attributes, representing a potential alternative for the bakery industry.