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Business combinations - Schedule of Acquisitions, PRA Acquisition (Details) - USD ($) | Dec. 31, 2021 | Jul. 01, 2021 | Dec. 31, 2020 | Dec. 31, 2019
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Business Acquisition [Line Items] |  |  |  |
Goodwill | $ 9,037,931,000 |  | $ 936,257,000 | $ 883,170,000
PRA Health Sciences, Inc |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Cash and cash equivalents |  | $ 259,971,000 |  |
Accounts receivable and unbilled revenue |  | 934,308,000 |  |
Other current assets |  | 125,156,000 |  |
Fixed assets |  | 156,851,000 |  |
Operating lease right-of-use assets |  | 177,345,000 |  |
Goodwill |  | 8,120,006,000 |  |
Intangible assets |  | 4,886,000,000 |  |
Deferred tax assets |  | 28,099,000 |  |
Other assets |  | 35,391,000 |  |
Accounts payable |  | (50,259,000) |  |
Accrued expenses and other current liabilities |  | (380,342,000) |  |
Current portion of operating lease liabilities |  | (36,625,000) |  |
Unearned revenue |  | (739,278,000) |  |
Non-current portion of operating lease liabilities |  | (144,403,000) |  |
Deferred tax liabilities |  | (1,126,952,000) |  |
Other non-current liabilities |  | (203,297,000) |  |
Net assets acquired |  | 12,041,971,000 |  |
Goodwill, expected tax deductible amount |  | $ 0 |  |

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