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Intangible assets (Details) - USD ($)
$ in Thousands
Mar. 31, 2022
Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 5,079,026 $ 5,081,381
Accumulated amortization (486,439) (370,538)
 Net book value 4,592,587 4,710,843
Customer relationships    
Finite-Lived Intangible Assets [Line Items]    
Total cost 4,055,260 4,056,642
Order backlog    
Finite-Lived Intangible Assets [Line Items]    
Total cost 527,451 528,022
Trade names & brands    
Finite-Lived Intangible Assets [Line Items]    
Total cost 204,648 204,685
Patient database    
Finite-Lived Intangible Assets [Line Items]    
Total cost 170,456 170,525
Technology assets    
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 121,211 $ 121,507