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Intangible assets (Tables)
3 Months Ended
Mar. 31, 2025
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Finite-Lived Intangible Assets
Estimated Useful Life
Customer relationships
8 - 23 years
Order backlog
       3 - 5 years
Patient database7 years
Technology assets5 years
The carrying amount of Intangible Assets as of March 31, 2025 and December 31, 2024 is as follows:

March 31,
2025
December 31,
2024
(in thousands)
Cost
Customer relationships$4,131,176 $4,129,501 
Order backlog544,618 543,933 
Trade names & brands204,631 204,588 
Patient database170,409 170,324 
Technology assets151,010 150,658 
Total cost5,201,844 5,199,004 
Accumulated amortization(1,700,537)(1,639,212)
 Net book value$3,501,307 $3,559,792