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Intangible Assets (Tables)
12 Months Ended
Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Finite-Lived Intangible Assets
Intangible assets are amortized on a straight-line basis over the expected useful life, as set forth in the table below:

Estimated Useful Life
Customer relationships23 years
Order backlog3 years
Trade names3 years
Patient database7 years
Technology assets5 years
The carrying amount of Intangible Assets for the years ended December 31, 2022 and 2021 is as follows:
December 31, 2022December 31, 2021
Cost(in thousands)
Customer relationships$4,076,435 $4,056,642 
Order backlog536,934 528,022 
Trade names & brands204,621 204,685 
Patient database170,238 170,525 
Technology assets120,984 121,507 
Total cost5,109,212 5,081,381 
Accumulated amortization(830,553)(370,538)
 
Net book value
$4,278,659 $4,710,843 
Schedule of Future Intangible Asset Amortization Expense
Future intangible asset amortization expense for the years ended December 31, 2023 to December 31, 2027 is as follows:
 Year Ended
December 31, 2022
(in thousands)
2023$460,711 
2024339,940 
2025223,674 
2026209,681 
2027198,300 
 $1,432,306