Intuitively, one only needs patients with two positive screening test results for positive predictive values comparison, and those with two negative screening test results for contrasting negative predictive values. Nevertheless, current existing methods rely on the multinomial model that includes superfluous parameters unnecessary for specific comparisons. This practice results in complex statistics formulas. We introduce a novel likelihood approach that fits the intuition by including a minimum number of parameters of interest in paired designs. It is demonstrated that our robust score test statistic is identical to a newly proposed weighted generalized score test statistic. Simulations and real data analysis are used for illustration.