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Intangible assets - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Cost    
Total cost $ 5,190,134 $ 5,147,971
Accumulated amortization (1,584,320) (1,292,106)
 Net book value 3,605,814 3,855,865
Customer relationships    
Cost    
Total cost 4,119,115 4,090,393
Order backlog    
Cost    
Total cost 544,546 541,302
Trade names & brands    
Cost    
Total cost 204,666 204,653
Patient database    
Cost    
Total cost 170,501 170,366
Technology assets    
Cost    
Total cost $ 151,306 $ 141,257