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Intangible Assets (Tables)
 12 Months Ended
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Finite-Lived Intangible Assets
Intangible assets are amortized on a straight-line basis over their estimated useful lives, as set forth in the table below:

Estimated Useful Life
Customer relationships
16 - 23 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, 2023 and 2022 is as follows:
December 31, 2023December 31, 2022
Cost(in thousands)
Customer relationships$4,090,393 $4,076,435 
Order backlog541,302 536,934 
Trade names & brands204,653 204,621 
Patient database170,366 170,238 
Technology assets141,257 120,984 
Total cost5,147,971 5,109,212 
Accumulated amortization(1,292,106)(830,553)
 
Net book value
$3,855,865 $4,278,659 
Schedule of Future Intangible Asset Amortization Expense
Future intangible asset amortization expense for the years ended December 31, 2024 to December 31, 2028 is as follows:
 (in thousands)
2024$344,518 
2025229,106 
2026214,869 
2027202,539 
2028189,539 
Total$1,180,571