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Business combinations - Narrative, PRA Acquisition (Details) $ / shares in Units, $ in Thousands |  | 6 Months Ended | 12 Months Ended
--- | --- | --- | ---
Jul. 01, 2021 Employee $ / shares shares | Dec. 31, 2021 USD ($) Employee | Dec. 31, 2021 USD ($) Employee | Dec. 31, 2020 USD ($) | Dec. 31, 2019 USD ($)
Business Acquisition [Line Items] |  |  |  |  |
Number of employees | Employee | 38,000 | 38,330 | 38,330 |  |
Transaction and integration related (Note 6) |  |  | $ 198,263 | $ (759) | $ 4,085
Total financing costs |  |  | 182,423 | 13,019 | 13,276
Transaction and one time financing costs |  |  | 75,391 | $ 0 | $ 0
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 (Note 6) |  |  | 198,300 |  |
Acquisition related costs |  |  | 57,100 |  |
Total financing costs |  |  | 86,700 |  |
Gross debt issuance costs |  | $ 76,200 | 76,200 |  |
Revenue of acquiree since acquisition date |  | 2,053,400 |  |  |
Pre-tax net income of acquiree since acquisition date |  | $ 169,900 |  |  |
Transaction and one time financing costs |  |  | $ 86,700 |  |

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