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Fair value of financial instruments and investments - Narrative (Details) - USD ($) |  | 1 Months Ended | 12 Months Ended |  |  |  |  |  |
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Apr. 29, 2020 | Jan. 31, 2020 | Dec. 31, 2020 | Dec. 31, 2019 | Sep. 30, 2019 | May 31, 2019 | Dec. 31, 2018 | Aug. 23, 2018 | Apr. 30, 2018 | Aug. 31, 2015
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Share price (in USD per share) |  |  |  |  |  |  |  |  | $ 27.04 |
Unrealized (gains) losses |  |  | $ 14,310,000 | $ 2,194,000 |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Purchase of convertible note |  | $ 10,000,000.0 | 10,000,000 |  |  |  |  |  |  |
Conversion price - convertible note |  | $ 6.00 |  |  |  |  |  |  |  |
Term of convertible note |  | 5 years |  |  |  |  |  |  |  |
Unrealized gain on convertible note |  |  | 19,252,000 |  |  |  |  |  |  |
Transfers from Level 1 to Level 2 |  |  | 0 | 0 |  |  |  |  |  |
Transfers from Level 2 to Level 1 |  |  | 0 | 0 |  |  |  |  |  |
Write downs of available for sale debt securities |  |  | 0 |  |  |  |  |  |  |
Increase in allowance for credit losses |  |  | 0 |  |  |  |  |  |  |
Realized gain (loss) from sale of marketable securities |  |  | 700,000 | 0 |  |  |  |  |  |
Deferred consideration payable |  |  | 0 |  |  |  |  |  |  |
Payments on deferred consideration obligation |  |  | 38,100,000 |  |  |  |  |  |  |
Issuance of common stock related to rights exchange |  |  | 150,528,000 |  |  |  |  |  |  |
Contingent consideration payable |  |  | 240,400,000 | 356,300,000 |  |  |  |  |  |
Deferred consideration payable |  |  |  | 40,000,000 |  |  |  |  |  |
3.00% Convertible senior notes due 2022 | Convertible debt |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Principal |  |  | 150,000,000 | 150,000,000 |  |  |  |  |  | $ 150,000,000.0
Interest rate ( as a percent ) |  |  |  |  |  |  |  |  |  | 3.00%
1.50% Convertible senior notes due 2026 | Convertible debt |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Principal |  |  | 287,500,000 | 287,500,000 | $ 287,500,000 |  |  |  |  |
Interest rate ( as a percent ) |  |  |  |  | 1.50% |  |  |  |  |
SARs |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 0 |  |  |  |  |  |  |
Level 2 |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
ClearPoint convertible debt security |  |  | 29,300,000 |  |  |  |  |  |  |
Level 2 | 3.00% Convertible senior notes due 2022 | Convertible debt |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Fair value of convertible notes |  |  | 193,200,000 | 171,200,000 |  |  |  |  |  |
Level 2 | 1.50% Convertible senior notes due 2026 | Convertible debt |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Fair value of convertible notes |  |  | 394,900,000 | 335,000,000.0 |  |  |  |  |  |
Level 3 |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
ClearPoint convertible debt security |  |  | 0 |  |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 101,200,000 |  |  |  |  |  |  |
Level 3 | SARs |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 0 | 3,186,000 |  |  | $ 3,814,000 |  |  |
Recurring basis | Level 1 |  |  |  |  |  |  |  |  |  |
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Fair value of equity investment |  |  | 20,503,000 | 6,194,000 |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
ClearPoint convertible debt security |  |  | 0 |  |  |  |  |  |  |
Deferred consideration payable |  |  |  | 0 |  |  |  |  |  |
Stock appreciation rights liability |  |  |  | 0 |  |  |  |  |  |
Contingent consideration payable |  |  | 0 | 0 |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 0 | 0 |  |  |  |  |  |
Recurring basis | Level 2 |  |  |  |  |  |  |  |  |  |
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Fair value of equity investment |  |  | 0 | 0 |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
ClearPoint convertible debt security |  |  | 29,252,000 |  |  |  |  |  |  |
Deferred consideration payable |  |  |  | 40,000,000 |  |  |  |  |  |
Stock appreciation rights liability |  |  |  | 0 |  |  |  |  |  |
Contingent consideration payable |  |  | 0 | 0 |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 0 | 0 |  |  |  |  |  |
Recurring basis | Level 3 |  |  |  |  |  |  |  |  |  |
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Fair value of equity investment |  |  | 0 | 0 |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Deferred consideration payable |  |  |  | 0 |  |  |  |  |  |
Stock appreciation rights liability |  |  |  | 3,186,000 |  |  |  |  |  |
Contingent consideration payable |  |  | 139,200,000 | 290,500,000 |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  |  | 65,800,000 |  |  |  |  |  |
Regulatory Milestones | Nonrecurring basis | Level 3 |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Gain (loss) recognized on change in fair value on contingent consideration forfeited by Participating Rightholders |  |  | 1,000,000.0 |  |  |  |  |  |  |
Agilis |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Development milestone payment obligations |  |  | 40,000,000.0 |  |  |  |  |  |  |
Deferred consideration payable |  |  |  |  |  |  |  | $ 38,100,000 |  |
Agilis | Maximum |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Development milestone payment obligations |  |  | 60,000,000.0 |  |  |  |  |  |  |
Priority review voucher amount |  |  | 535,000,000.0 |  |  |  |  |  |  |
Agilis | Development and Regulatory Milestone | Level 3 | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 139,200,000 | 290,500,000 |  |  | 257,040,000 |  |  |
Agilis | Net Sales Milestones and Royalties | Level 3 | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | 101,200,000 | 65,800,000 |  |  | $ 53,200,000 |  |  |
Agilis Merger Agreement | Agilis |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Development milestone payment obligations |  |  | 40,000,000.0 |  |  |  |  | $ 40,000,000.0 |  |
Payments on deferred consideration obligation |  |  | 2,400,000 |  |  |  |  |  |  |
Agilis Merger Agreement | Agilis | Maximum |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Development milestone payment obligations |  |  | 60,000,000.0 |  |  |  |  |  |  |
Priority review voucher amount |  |  | $ 535,000,000.0 |  |  |  |  |  |  |
Rights Exchange Agreement |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Shares issued under Rights Exchange Agreement | 2,821,176 |  | 2,821,176 |  |  |  |  |  |  |
Cash consideration payment under Rights Exchange Agreement | $ 36,900,000 |  | $ 36,900,000 |  |  |  |  |  |  |
Issuance of common stock related to rights exchange |  |  | 150,500,000 |  |  |  |  |  |  |
Transaction fees |  |  | 2,000,000.0 |  |  |  |  |  |  |
Rights Exchange Agreement | Regulatory Milestones |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Amount of potential future milestone payments forfeited by Participating Rightholders |  |  | 174,000,000.0 |  |  |  |  |  |  |
Settled value of milestone payments |  |  | 139,200,000 |  |  |  |  |  |  |
Gain (loss) recognized on settlement of milestones |  |  | (11,300,000) |  |  |  |  |  |  |
Rights Exchange Agreement | Development Milestones |  |  |  |  |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
Amount of potential future milestone payments forfeited by Participating Rightholders |  |  | 37,600,000 |  |  |  |  |  |  |
Settled value of milestone payments |  |  | 37,600,000 |  |  |  |  |  |  |
Gain (loss) recognized on settlement of milestones |  |  | 700,000 |  |  |  |  |  |  |
Total | Recurring basis |  |  |  |  |  |  |  |  |  |
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Fair value of equity investment |  |  | 20,503,000 | 6,194,000 |  |  |  |  |  |
ClearPoint Convertible note |  |  |  |  |  |  |  |  |  |
ClearPoint convertible debt security |  |  | 29,252,000 |  |  |  |  |  |  |
Deferred consideration payable |  |  |  | 40,000,000 |  |  |  |  |  |
Stock appreciation rights liability |  |  |  | 3,186,000 |  |  |  |  |  |
Contingent consideration payable |  |  | 139,200,000 | 290,500,000 |  |  |  |  |  |
Contingent consideration payable- net sales milestones and royalties |  |  | $ 101,200,000 | $ 65,800,000 |  |  |  |  |  |
Common stock |  |  |  |  |  |  |  |  |  |
ClearPoint Equity Investment |  |  |  |  |  |  |  |  |  |
Shares purchased |  |  |  |  |  | $ 4,000,000.0 |  |  |  |
Share price (in USD per share) |  |  |  |  |  | $ 3.10 |  |  |  |

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