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Intangible assets (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 5,103,413 $ 5,081,381
Accumulated amortization (711,714) (370,538)
 Net book value 4,391,699 4,710,843
Customer relationships    
Finite-Lived Intangible Assets [Line Items]    
Total cost 4,072,988 4,056,642
Order backlog    
Finite-Lived Intangible Assets [Line Items]    
Total cost 535,557 528,022
Trade names & brands    
Finite-Lived Intangible Assets [Line Items]    
Total cost 204,536 204,685
Patient database    
Finite-Lived Intangible Assets [Line Items]    
Total cost 170,049 170,525
Technology assets    
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 120,283 $ 121,507