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Intangible assets - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)
$ in Thousands
Sep. 30, 2025
Dec. 31, 2024
Cost    
Total cost $ 5,206,920 $ 5,199,004
Accumulated amortization (1,822,598) (1,639,212)
 Net book value 3,384,322 3,559,792
Customer relationships    
Cost    
Total cost 4,134,107 4,129,501
Order backlog    
Cost    
Total cost 545,922 543,933
Trade names & brands    
Cost    
Total cost 204,713 204,588
Patient database    
Cost    
Total cost 170,487 170,324
Technology assets    
Cost    
Total cost $ 151,691 $ 150,658