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Commitment and contingencies - Narrative (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Other Commitments [Line Items]      
Operating leases expense $ 84 $ 81 $ 78
Active Pharmaceutical Ingredient [Member]      
Purchase Commitments, Fiscal Year Maturity      
2018 902    
2019 179    
2020 50    
2021 48    
2022 45    
Actual payments for purchases related to active pharmaceutical ingredients $ 1,700 $ 2,000 $ 2,200