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Business combinations - Fair Value of Consideration Transferred, PRA Acquisition (Details) - USD ($) $ in Thousands |  | 12 Months Ended
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Jul. 01, 2021 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Business Acquisition [Line Items] |  |  |  |
Fair value of cash consideration |  | $ 5,914,475 | $ 47,931 | $ 131,272
PRA Health Sciences, Inc |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Fair value of cash consideration | $ 5,308,646 |  |  |
Fair value of ordinary shares issued to acquiree stockholders | 5,658,126 |  |  |
Fair value of replacement share-based awards issued to acquiree employees | 209,399 |  |  |
Repayment of term loan obligations and accrued interest | 865,800 |  |  |
Consideration transferred | 12,041,971 |  |  |
Payments to settle debt obligations that existed prior to acquisition date | $ 401,600 |  |  |

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