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Business combinations - Narrative (Details) $ / shares in Units, $ in Thousands |  | 3 Months Ended | 9 Months Ended |
--- | --- | --- | --- | ---
Jul. 01, 2021 Employee Country $ / shares shares | Sep. 30, 2021 USD ($) | Sep. 30, 2020 USD ($) | Sep. 30, 2021 USD ($) | Sep. 30, 2020 USD ($) | Jan. 22, 2020
Business Acquisition [Line Items] |  |  |  |  |  |
Entity number of employees | Employee | 37,960 |  |  |  |  |
Number of countries in which entity operates | Country | 53 |  |  |  |  |
Transaction and integration-related expenses |  | $ 149,791 | $ 402 | $ 182,309 | $ (497) |
PRA Health Sciences Inc |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Business acquisition, share price (in USD per share) | $ / shares | $ 80 |  |  |  |  |
Business acquisition, number of shares issued (in shares) | shares | 0.4125 |  |  |  |  |
Transaction and integration-related expenses |  |  |  | 182,300 |  |
Interest expense |  |  |  | 78,200 |  |
Deferred financing cost |  | 76,200 |  | $ 76,200 |  |
Revenue of acquiree since acquisition date |  | 1,019,700 |  |  |  |
Net income of acquiree since acquisition date |  | $ 113,400 |  |  |  |
Medpass |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Percentage of share capital acquired |  |  |  |  |  | 100.00%

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