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Intangible assets (Tables)
9 Months Ended
Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Finite-Lived Intangible Assets
Intangible assets, net consisted of the following:
Nine Months EndedYear Ended
September 30, 2021December 31, 2020
Cost(in thousands)
Customer relationships$4,047,002 $144,251 
Order backlog527,324 39,269 
Trade names & brands204,705 2,766 
Patient database170,513 2,552 
Technology assets121,672 11,173 
Total cost5,071,216 200,011 
Accumulated amortization(256,032)(133,551)
 Net book value$4,815,184 $66,460