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Income Taxes - Reconciliation of Tax Rate (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Effective Income Tax Rate Reconciliation, Percent [Abstract] |  |  |
Statutory tax rate | 12.50% | 12.50% | 12.50%
Differences in international tax rates | (34.50%) | 3.20% | 8.00%
Nondeductible changes in fair value of contingent consideration | (19.40%) | (0.30%) | 4.00%
Intercompany asset transfer | 0.00% | 21.20% | 0.00%
Change in valuation allowances | (83.30%) | (19.10%) | (5.30%)
Nondeductible stock-based compensation | (20.90%) | (2.70%) | (1.30%)
Hospital Products sale | 183.50% | 0.00% | 0.00%
Unrealized tax benefits | 5.40% | 0.70% | (1.30%)
State and local taxes (net of federal) | (0.40%) | 0.00% | (0.30%)
Change in U.S. tax law | 179.50% | 0.00% | (0.20%)
Nondeductible interest expense | (34.00%) | (2.50%) | (1.10%)
Orphan drug and R&D tax credit | 55.00% | 0.00% | 0.00%
Other | (5.10%) | 0.90% | 0.70%
Effective income tax rate | 238.30% | 13.90% | 15.70%
Effective Income Tax Rate Reconciliation, Amount [Abstract] |  |  |
Income tax benefit - at statutory tax rate | $ (636) | $ (4,823) | $ (14,149)
Differences in international tax rates | 1,755 | (1,218) | (9,039)
Nondeductible changes in fair value of contingent consideration | 988 | 121 | (4,559)
Intercompany asset transfer | 0 | (8,190) | 0
Change in valuation allowances | 4,231 | 7,379 | 5,998
Nondeductible stock-based compensation | 1,060 | 1,039 | 1,499
Hospital Products sale | (9,328) | 0 | 0
Unrecognized tax benefits | (274) | (261) | 1,440
State and local taxes (net of federal) | 20 | (7) | 299
Change in U.S. tax law | (9,124) | 0 | 274
Nondeductible interest expense | 1,728 | 982 | 1,269
Orphan drug and R&D tax credit | (2,793) | 0 | 0
Other | 263 | (378) | (925)
Income tax benefit | $ (12,110) | $ (5,356) | $ (17,893)

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