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Intangible assets (Details) - USD ($)
$ in Thousands
Sep. 30, 2023
Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 5,108,471 $ 5,109,212
Accumulated amortization (1,173,798) (830,553)
 Net book value 3,934,673 4,278,659
Customer relationships    
Finite-Lived Intangible Assets [Line Items]    
Total cost 4,076,010 4,076,435
Order backlog    
Finite-Lived Intangible Assets [Line Items]    
Total cost 536,716 536,934
Trade names & brands    
Finite-Lived Intangible Assets [Line Items]    
Total cost 204,608 204,621
Patient database    
Finite-Lived Intangible Assets [Line Items]    
Total cost 170,262 170,238
Technology assets    
Finite-Lived Intangible Assets [Line Items]    
Total cost $ 120,875 $ 120,984