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Intangible assets (Tables)
 6 Months Ended
Jun. 30, 2024
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 periods ended June 30, 2024 and December 31, 2023 is as follows:

June 30,
2024		December 31,
2023
(in thousands)
Cost
Customer relationships$4,089,261 $4,090,393 
Order backlog540,795 541,302 
Trade names & brands204,621 204,653 
Patient database170,348 170,366 
Technology assets150,933 141,257 
Total cost5,155,958 5,147,971 
Accumulated amortization(1,523,604)(1,292,106)
 Net book value$3,632,354 $3,855,865