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Fair value of financial instruments and marketable securities - Narrative (Details) | 1 Months Ended | 3 Months Ended | 9 Months Ended |  |  |  |  |
--- | --- | --- | --- | --- | --- | --- | --- | ---
Aug. 31, 2021 USD ($) | Feb. 28, 2021 USD ($) fund $ / shares | Jan. 31, 2020 USD ($) $ / shares | Sep. 30, 2021 USD ($) | Sep. 30, 2020 USD ($) | Sep. 30, 2021 USD ($) | Sep. 30, 2020 USD ($) shares | Dec. 31, 2020 USD ($) | Apr. 29, 2020 | Sep. 30, 2019 USD ($) $ / shares | May 31, 2019 USD ($) $ / shares | Aug. 31, 2015 USD ($) $ / shares
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Write downs of available for sale debt securities |  |  |  | $ 0 |  | $ 0 |  |  |  |  |  |
Realized gain (loss) from sale of marketable securities |  |  |  | 0.0 | $ 300,000 | 700,000 | $ 500,000 |  |  |  |  |
Increase in allowance for credit losses |  |  |  | 0 | 0 | 0 | 0 |  |  |  |  |
Unrealized gain (loss) on ClearPoint Equity Investment |  |  |  | (1,700,000) | 2,500,000 | 2,376,000 | 852,000 |  |  |  |  |
Marketable securities - equity investments |  |  |  | 23,000,000.0 |  | 23,000,000.0 |  | $ 20,500,000 |  |  |  |
Purchase of convertible debt investment |  |  | $ 10,000,000.0 |  |  |  | 10,000,000 |  |  |  |  |
Conversion price per share (in dollars per share) | $ / shares |  |  | $ 6.00 |  |  |  |  |  |  |  |  |
Debt instrument, convertible, period |  |  | 5 years |  |  |  |  |  |  |  |  |
Unrealized loss |  |  |  | 2,300,000 |  |  | 600,000 |  |  |  |  |
Unrealized gain on convertible note |  |  |  |  | 1,400,000 | 2,100,000 |  |  |  |  |  |
Fair value of convertible debt |  |  |  | 31,300,000 |  | 31,300,000 |  | 29,300,000 |  |  |  |
Purchase of marketable securities - equity investments | $ 5,400,000 | $ 200,000,000.0 |  |  |  | 205,382,000 |  |  |  |  |  |
Number of mutual funds invested in | fund |  | 2 |  |  |  |  |  |  |  |  |  |
Redemption of marketable securities- equity investments |  |  |  | 700,000 |  | 740,000 |  |  |  |  |  |
Unrealized gain on marketable securities - equity investments |  |  |  | 700,000 |  | 1,400,000 |  |  |  |  |  |
Unrealized foreign currency losses on equity investments |  |  |  | 200,000 |  | 200,000 |  |  |  |  |  |
Transfers of assets measured between Level 1, Level 2, and Level 3 |  |  |  | 0 |  | 0 |  | 0 |  |  |  |
Non-cash stock consideration, acquisition |  |  |  |  |  |  | 42,869,000 |  |  |  |  |
Operating Expenses |  |  |  | 231,819,000 | 173,535,000 | 663,077,000 | 597,296,000 |  |  |  |  |
Business Combination, Contingent Consideration Arrangements, Change in Amount of Contingent Consideration, Asset |  |  |  | (10,800,000) | $ (8,400,000) | (11,600,000) | $ (16,980,000) |  |  |  |  |
Common stock |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Issuance of common stock related to rights exchange (in shares) | shares |  |  |  |  |  |  | 2,821,176 |  |  |  |  |
3.00% Convertible senior notes due 2022 | Convertible debt |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Principal |  |  |  | 150,000,000 |  | 150,000,000 |  | 150,000,000 |  |  |  | $ 150,000,000.0
Interest rate ( as a percent ) |  |  |  |  |  |  |  |  |  |  |  | 3.00%
Fair value of convertible notes |  |  |  | 155,500,000 |  | 155,500,000 |  | 193,200,000 |  |  |  |
Conversion price per share (in dollars per share) | $ / shares |  |  |  |  |  |  |  |  |  |  |  | $ 56.34
1.50% Convertible senior notes due 2026 | Convertible debt |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Principal |  |  |  | $ 287,500,000 |  | $ 287,500,000 |  | 287,500,000 |  | $ 287,500,000 |  |
Interest rate ( as a percent ) |  |  |  | 1.50% |  | 1.50% |  |  |  | 1.50% |  |
Fair value of convertible notes |  |  |  | $ 294,900,000 |  | $ 294,900,000 |  | 394,900,000 |  |  |  |
Conversion price per share (in dollars per share) | $ / shares |  |  |  |  |  |  |  |  |  | $ 52.52 |  |
Agilis |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Development milestone payments which the entity is obligated to pay |  |  |  | $ 40,000,000.0 |  | $ 40,000,000.0 |  |  |  |  |  |
Agilis | Minimum |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Product sales (as a percent) |  |  |  | 2.00% |  | 2.00% |  |  | 2.00% |  |  |
Agilis | Maximum |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Product sales (as a percent) |  |  |  | 6.00% |  | 6.00% |  |  | 6.00% |  |  |
Development milestone payments which the entity is obligated to pay |  |  |  | $ 60,000,000.0 |  | $ 60,000,000.0 |  |  |  |  |  |
Priority review voucher amount |  |  |  |  |  | 535,000,000.0 |  |  |  |  |  |
Net sales amount |  |  |  | 150,000,000.0 |  | 150,000,000.0 |  |  |  |  |  |
Recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Fair value of convertible debt |  |  |  | $ 31,306,000 |  | $ 31,306,000 |  | $ 29,252,000 |  |  |  |
Common stock |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Shares purchased |  | $ 100,000 |  |  |  |  |  |  |  |  | $ 4,000,000.0 |
Share price (in USD per share) | $ / shares |  | $ 23.50 |  |  |  |  |  |  |  |  | $ 3.10 |
Development and Regulatory Milestone | Probability of Success | Weighted Average | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Rights Exchange settlement |  |  |  | 42 |  | 42 |  |  |  |  |  |
Development and Regulatory Milestone | Agilis | Measurement Input, Discount Rate | Weighted Average | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Rights Exchange settlement |  |  |  | 3.3 |  | 3.3 |  |  |  |  |  |
Net Sales Milestones and Royalties | Probability of Success | Weighted Average | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Rights Exchange settlement |  |  |  | 48 |  | 48 |  |  |  |  |  |
Net Sales Milestones and Royalties | Agilis | Measurement Input, Discount Rate | Contingent Consideration Payable |  |  |  |  |  |  |  |  |  |  |  |
Financial assets and liabilities measured at fair value on recurring basis |  |  |  |  |  |  |  |  |  |  |  |
Rights Exchange settlement |  |  |  | 0.110 |  | 0.110 |  |  |  |  |  |

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