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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