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Summary of significant accounting policies (Details) |  | 12 Months Ended |  |
--- | --- | --- | --- | ---
Jan. 01, 2016 USD ($) | Dec. 31, 2014 state | Sep. 30, 2016 USD ($) | Dec. 31, 2015 USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items] |  |  |  |
Minimum age of ambulatory patient |  | 5 years |  |
Number of member states of the European Economic Area | state |  | 31 |  |
Capitalized inventory |  |  | $ 1,300,000 |
Allowance for doubtful accounts receivable |  |  | 400,000 | $ 0
Accounting Standards Update 2015-03 | Deposits and other assets |  |  |  |
New Accounting Pronouncements or Change in Accounting Principle [Line Items] |  |  |  |
Debt issuance cost | $ (2,800,000) |  |  |
Accounting Standards Update 2015-03 | Long-term debt. |  |  |  |
New Accounting Pronouncements or Change in Accounting Principle [Line Items] |  |  |  |
Debt issuance cost | $ 2,800,000 |  |  |
Unamortized debt issuance cost |  |  | $ 2,500,000 |
Minimum |  |  |  |
New Accounting Pronouncements or Change in Accounting Principle [Line Items] |  |  |  |
Gross profit margin (as a percent) |  |  | 90.00% |

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