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Intangible assets
9 Months Ended
Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Intangible assets Intangible assets
Intangible assets, net consisted of the following:
Nine Months EndedYear Ended
September 30, 2023December 31, 2022
Cost(in thousands)
Customer relationships$4,076,010 $4,076,435 
Order backlog536,716 536,934 
Trade names & brands204,608 204,621 
Patient database170,262 170,238 
Technology assets120,875 120,984 
Total cost5,108,471 5,109,212 
Accumulated amortization(1,173,798)(830,553)
 Net book value$3,934,673 $4,278,659 
The identifiable intangible assets are amortized over their estimated useful lives.