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Equity-based compensation - Summary of non-vested share movements (Details)
$ / shares in Units, shares in Thousands, $ in Thousands
 9 Months Ended 12 Months Ended
Apr. 08, 2019
USD ($)
shares
Dec. 31, 2019
USD ($)
shares
$ / shares
Dec. 31, 2018
USD ($)
shares
$ / shares
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Non-vested shares at January 1 (in shares)   4,222 2,800
Granted (in shares) 4,200 700  
Vested (in shares)   (108) (814)
Forfeited (in shares)   (114) (208)
Non-invested shares at December 31 (in shares) 4,222 4,742 3,443
Outstanding, beginning balance, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 74.4
Vested, weighted average fair value at grant date (in dollars per share) | $ / shares     93.0
Forfeited, weighted average fair value at grant date (in dollars per share) | $ / shares     80.4
Outstanding, ending balance, weighted average fair value at grant date (in dollars per share) | $ / shares   $ 51.2 $ 72.9
Fair value, beginning balance, non-vested | $   $ 212,367 $ 208,300
Fair value, vested | $   (5,432) (75,702)
Fair value, forfeited | $   (5,734) (16,723)
Fair value, ending balance, non-vested | $ $ 212,367 $ 243,020 $ 251,046
Restricted awards [Member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)   625  
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares   $ 56.1  
Fair value, granted | $   $ 35,037  
Performance awards [Member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)   117  
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares   $ 58.0  
Fair value, granted | $   $ 6,782  
Annual incentive [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     168
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 83.7
Fair value, granted | $     $ 14,062
Share savings plans [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     109
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 85.5
Fair value, granted | $     $ 9,320
Novartis equity plan select, North America [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     689
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 77.9
Fair value, granted | $     $ 53,673
Novartis equity plan select, outside North America [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     141
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 79.8
Fair value, granted | $     $ 11,252
Long-term performance plan [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     316
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 88.4
Fair value, granted | $     $ 27,934
Long-term relative performance plan [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     37
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 51.2
Fair value, granted | $     $ 1,894
Other share awards [member]      
Disclosure of terms and conditions of share-based payment arrangement [line items]      
Granted (in shares)     205
Granted, weighted average fair value at grant date (in dollars per share) | $ / shares     $ 83.1
Fair value, granted | $     $ 17,036