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Intangible assets (Tables)
3 Months Ended
Mar. 31, 2023
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
Intangible assets, net consisted of the following:
Three Months EndedYear Ended
March 31, 2023December 31, 2022
Cost(in thousands)
Customer relationships$4,077,267 $4,076,435 
Order backlog537,247 536,934 
Trade names & brands204,640 204,621 
Patient database170,298 170,238 
Technology assets121,141 120,984 
Total cost5,110,593 5,109,212 
Accumulated amortization(946,183)(830,553)
 Net book value$4,164,410 $4,278,659